RADICAL CYSTECTOMY

Radical Cystectomy
FOR BLADDER CANCER for Bladder Cancer
CYSTECTOMY IS A SURGERY TO
REMOVE THE URINARY BLADDER.
THE PROCEDURE TO REMOVE THE
ENTIRE BLADDER IS CALLED A
RADICAL CYSTECTOMY. IN MEN,
THIS TYPICALLY INCLUDES
REMOVAL OF THE PROSTATE AND
SEMINAL VESICLES. IN WOMEN,
RADICAL CYSTECTOMY USUALLY
INCLUDES REMOVAL OF THE
UTERUS, OVARIES, FALLOPIAN
TUBES AND PART OF THE VAGINA
 ANATOMY OF THE URINARY TRACT
KIDNEYS:
FILTER THE BLOOD.
PRODUCE URINE.
URETERS:
CARRIES URINE FROM THE
KIDNEYS TO THE BLADDER.
BLADDER:
STORES AND EMPTIES THE URINE.
URETHRA:
CARRIES URINE FROM THE
BLADDER OUTSIDE OF THE BODY.
 LAYER OF
Layer of Bladder Wall
BLADDER WALL
 FACTS ABOUT BLADDER CANCER

- PREVALENCE:
5TH MOST COMMON CANCER IN MEN.
8TH MOST COMMON CANCER IN WOMEN.

- MOST COMMONLY RELATED TO TOBACCO

EXPOSURE.

- DICHOTOMOUS PRESENTATION:
2/3RD PRESENT WITH NON-INVASIVE DISEASE.
1/3RD PRESENT WITH MORE ADVANCED
DISEASE.
GRADING OF BLADDER
Grading Of Bladder CanceR
CANCER
PROBLEMS WITH BLADDER
CANCER?

- HIGH RECURRENCE RATE:

IT TENDS TO COME BACK AFTER
TREATMENT.

- POSSIBILITY OF PROGRESSION:
INVADES DEEPER INTO THE BLADDER
WALL.
INDICATIONS FOR SURGERY

- INVASIVE BLADDER CANCER.

- SELECT PATIENTS WITH HIGH-RISK NON-
INVASIVE CANCER.
- AFTER FAILURE WITH BCG THERAPY:
NON-INVASIVE BLADDER CANCER.
CARCINOMA IN-SITU.
OTHER TREATMENT OPTIONS FOR MUSCLE INVASIVE
BLADDER CANCER
- NEOADJUVANT CHEMOTHERAPY FOLLOWED BY CYSTECTOMY AND
URINARY DIVISION.
- TRIMODALITY THERAPY (BLADDER SPARING):
MAXIMAL TRANSURETHRAL RESECTION OF BLADDER TUMOR.
CHEMOTHERAPY + RADIATION THERAPY.
- PALLIATIVE LOCAL THERAPY (NOT CURATIVE):
REPEAT SCRAPING T U R B T.
- NO THERAPY-SUPPORTIVE CARE/COMFORT/HOSPICE (USUALLY ONLY
IN TERMINALLY ILL PATIENTS).
 MALE
ANATOMY
WHAT IS REMOVED IN MEN

BLADDER.
PROSTATE AND SEMINAL
VESICLES
SOMETIMES THE URETHRA.
PELVIC LYMPH NODES.
 FEMALE
ANATOMY
WHAT IS REMOVED IN WOMEN

BLADDER.
SOMETIMES THE URETHRA.
SOMETIMES THE UTERUS AND
CERVIX.
PORTION OF THE VAGINA.
SOMETIMES THE FALLOPIAN TUBES
AND OVARIES.
PELVIC LYMPH NODES.
WHAT HAPPENS TO THE URINE
AFTER REMOVAL OF THE BLADDER

URINARY DIVERSION:
ILEAL CONDUIT (I.E. URINE BAG).
NEOBLADDER (I.E. NEW BLADDER).
CONTINENT CUTANEOUS POUCH.
ILEAL CONDUIT (I.E. ILEAL LOOP)

MOST COMMON TYPE OF URINARY DIVERSION.

SIMPLEST OF URINARY DIVERSIONS.
HARVEST A SEGMENT OF INTESTINES.
DRAIN URINE CONTINUOUSLY INTO BAG.
 ADVANTAGES OF ILEAL
CONDUIT

EASIEST OPERATION ON SURGEON.

SHORTER OPERATIVE TIME.
NO NEED FOR TUBES.
EASY TO LEARN.
EMPTY BAG APPROXIMATELY EVERY 4
HOURS.
CHANGE BAG EVERY 4-6 DAYS.
NO PHYSICAL LIMITATIONS.
 DISDVANTAGES OF
ILEAL CONDUIT

- ALTERED BODY IMAGE

- POSSIBILITY OF ACCIDENTS
- NEED TO CARRY SUPPLIES
- DIFFICULT TO HIDE
 NEOBLADDER

HARVEST A SEGMENT OF

INTESTINE

RECONFIGURE THE BOWEL INTO

THE SPHERICAL POUCH

ATTACH POUCH TO THE

URETHRA
NEOBLADDER RECOVERY
- LEAVE THE HOSPITAL WITH TEMPORARY TUBES:
URETHRAL CATHETER.
NEOBLADDER TUBE.
+/- SURGICAL DRAIN.
- RE-LEARN HOW TO URINATE:
BEAR DOWN ON ABDOMINAL MUSCLES TO SQUEEZE NEOBLADDER.
STRENGTHENING THE SPHINCTER.
POTENTIAL NEED TO INTERMITTENTLY CATHETERIZE.
- CATHETERIZE & IRRIGATE NEOBLADDER INTERMITTENTLY TO
PREVENT MUCOUS PLUGGING.
 ADVANTAGES OF A NEOBLADDER

NO DRAMATIC CHANGE IN
BODY IMAGE.
NO NEED TO WEAR AN
APPLIANCE OR BAG.
URINATE IN TOILET AS
BEFORE SURGERY.
DISADVANTAGES OF A NEOBLADDER
LONGER OPERATIVE TIME (> 2 HOURS).
MORE WORK FOR PATIENTS.
SLIGHTLY HIGHER COMPLICATION RATE.
RISK OF INCONTINENCE (LEAKAGE OF URINE),
PARTICULARLY AT NIGHT.
HIGHER RATE OF DIARRHEA.
CONTINENT CUTANEOUS POUCH
RARELY PERFORMED.
POUCH MADE FROM BOWEL WITH
CONNECTING SEGMENT TO SKIN.
CATHETER INSERTED EVERY 4-6 HOURS TO
EMPTY URINE.
PERFORMED IN YOUNGER PATIENTS WHO
MUST HAVE THE URETHRA REMOVED.
HIGHER RATE OF STOMAL COMPLICATIONS.
RISK OF INCONTINENCE.
RISK OF STONE FORMATION
 NON-ORTHOTOPIC
CONTINENT CONTINENT DIVERSION
CUTANEOUS
POUCH
INTRA OR PERI-OPERATIVE
BLEEDING ... REQUIRES TRANSFUSIONS
IN ABOUT 50% OF CASES.
INJURY TO THE RECTUM IN ABOUT 1-2%
OF CASES... MAY NEED A COLOSTOMY. WHAT ARE
INFECTION (WOUND OR ABSCESS). THE RISKS
NERVE INJURY WITH LEG WEAKNESS.
WORSENING KIDNEY FUNCTION.
WITH
BLOOD CLOTS (LEG OR LUNGS). SURGERY?
HEART ATTACK.
STROKE.
PNEUMONIA.
DEATH.
LATER OR CHRONIC
UTI.
BOWEL OBSTRUCTION... 5-10% RISK
WHAT ARE
LIFELONG.
URETERAL OBSTRUCTION... 5% RISK. THE RISKS
STOMAL STENOSIS OR HERNIA. WITH
URINARY LEAKAGE.
ERECTILE DYSFUNCTION.... GREATER THAN
SURGERY?
50% OF MEN.
LOSS OF PENILE LENGTH OR CURVATURE.
HOW LONG IS THE SURGERY?

APPROXIMATELY 4-6 HOURS.

ANOTHER 2 HOURS MAY BE NEEDED FOR
NEOBLADDERS OR CATHETERIZED POUCHES.
ADDITIONAL TIME MAY BE NEEDED FOR
COMPLICATED CASES.
 EXPECTATIONS FOR THE PATIENT HOSPITAL
RECOVERY

- NO FOOD OR DRINK UNTIL YOU PASS GAS (ROUGHLY 3-4 DAYS):

MAY HAVE A TUBE IN THE NOSE TO DRAIN THE STOMACH FOR 1-2
DAYS.
- TO PREVENT BLOOD CLOTS:
EXTERNAL LEG PUMPS SQUEEZE YOUR CALVES.
INJECTION OF BLOOD THINNERS.
- TO PREVENT PNEUMONIA
- PAIN CONTROL WITH A PATIENT-CONTROLLED BUTTON.
- WALKING IS THE FASTEST ROUTE TO RECOVERY.
THE SURGICAL DRAIN

YOU WILL HAVE A DRAIN PLACED AT THE

TIME OF SURGERY.
FOR MOST PATIENTS WITH AN ILEAL
CONDUIT, THESE WILL BE REMOVED PRIOR
TO DISCHARGE.
SOME PATIENT'S WILL GO HOME WITH
THESE AND WILL BE TAUGHT HOW TO
EMPTY AND MEASURE THEM.
THE CATHETER
HOSPITAL COURSE
- STAY IS 7-10 DAYS ON AVERAGE (NEOBLADDERS PERHAPS A DAY
LONGER).
- CANNOT GO HOME UNTIL:
EATING REGULAR FOOD.
PASSING GAS AND HAVING BOWEL MOVEMENTS.
WALKING.
ABLE TO USE UROSTOMY AFTER MEETING WITH ENTEROSTOMAL
THERAPIST.
TAKING ORAL PAIN MEDICATION FOR PAIN.
- IF YOU HAVE A NEOBLADDER:
WILL NEED TO LEARN TO IRRIGATE TUBES FOR WHEN YOU LEAVE.
WHAT TO EXPECT WITH RECOVERY

FULL RECOVERY IS ABOUT 8 WEEKS ON AVERAGE.

SHOULD BE ABLE TO WALK AND GO UP/DOWN STAIRS.
YOU CAN SHOWER WHEN YOU GET HOME (NO TUB BATHS).
YOU WILL GO HOME ON PAIN MEDICATION AND STOOL
SOFTENERS.
YOU WILL PROBABLY LOSE WEIGHT (5-10 LBS).
FOOD TASTES ODD FOR A WHILE (2-3 WEEKS).
WHAT TO EXPECT WITH RECOVERY CONT.
IF YOU HAVE AN APPLIANCE IT WILL LIKELY FALL OFF
AT THE MOST INOPPORTUNE TIME
PATIENTS COMMONLY HAVE DIARRHEA (1-2 WEEKS).
IF YOU BECOME CONSTIPATED TRY THE FOLLOWING
MEDICATION(S):
- MIRALAX.
- MILK OF MAGNESIA.
- MAGNESIUM CITRATE.
- DO NOT LIFT ANYTHING HEAVER THAN 20
LBS FOR 1ST TWO WEEKS:
CAN INCREASE BY 5 LBS PER WEEK.
- NO TUB BATHS FOR AT LEAST 2 WEEKS.
- EXPECT NOT TO DRIVE FOR AT LEAST A LIMITATIONS
WEEK OR TWO AFTER SURGERY:
NEED TO BE OFF OF NARCOTIC PAIN
MEDICATIONS.
- YOU WILL BE OFF OF WORK FOR 6-8 WEEKS.
OTHER THINGS TO EXPECT

- THE URINE WILL HAVE MUCOUS IN IT.

- YOU MAY SEE BLOOD IN THE URINE FOR WEEKS TO
MONTHS.
- YOU WILL GET TIRED EASILY:
YOU WILL LIKELY NEED NAPS.
YOU SHOULD INCREASE YOUR ACTIVITY LEVEL
DAILY.
WALKING IS GOOD.
CONTINUE TO EAT AS NUTRITION IS
VERY IMPORTANT IN HEALING FROM IS
MAJOR SURGERY. THERE
BLADDER CANCER PATIENTS COMMONLY SPECIAL
WILL HAVE POOR NUTRITION STATUS AS PREPARATION
THESE CANCERS CONSUME A LARGE FOR
AMOUNT OF NUTRITION. SURGERY?
YOU MAY WISH TO TAKE SUPPLEMENTS
KEEP ACTIVE.
CIGARETTE SMOKING
BOTH YOUR PROGNOSIS AND
RECURRENCE RATE WITH
BLADDER CANCER ARE
DEPENDENT ON NOT SMOKING.
YOUR RISK OF RECURRENCE IS
MUCH HIGHER IF YOU CONTINUE
TO SMOKE.
 THANK YOU
THANK YOU