cystectomy


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Cystectomy

 

Definition

Cystectomy is a surgical procedure to remove the bladder.

Purpose

Cystectomy is performed to treat cancer of the bladder. Radiation and chemotherapy are also used to treat bladder cancer. Surgery is used to remove cancer when it is in the muscle of the bladder.

Precautions

Cystectomy is an aggressive treatment that may not be appropriate for patients with superficial tumors that respond to more conservative treatment.

Description

Cystectomy is a major surgical operation. The patient is placed under general anesthesia. An incision is made across the lower abdomen. The ureters are located, tied and cut. The ureters connect the kidneys to the bladder. Cutting them frees the bladder for removal. The bladder and associated organs are removed. In men the prostate is removed with the bladder. In women, the uterus, fallopian tubes, ovaries, and part of the vagina are removed with the bladder. The bladder collects urine from the kidneys for excretion at a later time. Since the bladder is removed, a new method must be created to remove the urine. A small piece of the small intestine is removed, cleaned, and tied at one end to form a tube. The other end is used to form a stoma, an opening through the abdominal wall to the outside. The ureters are then connected to the tube. Urine produced by the kidneys now flows down the ureters, into the tube, and through the stoma. The patient wears a bag to collect the urine.

Preparation

The medical team will discuss the procedure and tell the patient where the stoma will appear and what it will look like. The patient receives instruction on caring for a stoma and bag. Counseling may be initiated. A period of fasting and an enema may be required.

Aftercare

After the operation, the patient is given fluidbased nutrition until the intestines being to function normally again. Antibiotics are given to prevent infection of the incision sites. The nature of the organs removed mean that there will be major lifestyle changes for the person undergoing the operation. Men will become impotent because nerves controlling penile erection are cut during removal of the bladder. In women, infertility is a consequence because the ovaries and uterus are removed. However, most women who undergo cystectomy are postmenopausal and past their childbearing years.
Both men and women are fitted with an external bag that connects to the stoma and collects the urine. The bag is generally worn around the waist under the clothing. It takes a period of adjustment to get used to wearing the bag. Because there is no bladder, urine is excreted as it is produced, essentially continuously. The stoma must be treated properly to ensure that it does not become infected or blocked. Patients must be trained to care for their stoma. Often there is a period of psychological adjustment to the major change in life style created by the stoma and bag. Patients should be prepared for this by discussion with their physician.

Risks

As with any major surgery, there is a risk of infection; in this case infection of the intestine is especially dangerous as it can lead to peritonitis (inflammation of the membrane lining the abdomen).

Key terms

Ureters — Tubes that connect the kidneys to the bladder. Urine produced by the kidneys passes through the ureters to the bladder.

Normal results

The bladder is successfully removed and a stoma created. Intestinal function returns to normal and the patient learns proper care of the stoma and bag. He or she adjusts to lifestyle changes and returns to a normal routine of work and recreation, some sports excluded.

Abnormal results

The patient develops an infection at the incision site. The patient does not make a successful psychological adjustment to the long term consequences of impotence and urinary diversion. In some women, the vagina is constricted, which may require a secondary procedure.

Resources

Books

Berkow, Robert, editor. Merck Manual of Medical Information. Whitehouse Station, NJ: Merck Research Laboratories, 2004.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.

cystectomy

 [sis-tek´to-me]
1. excision of a cyst.
2. excision or resection of the urinary bladder.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

cys·tec·to·my

(sis-tek'tō-mē),
1. Excision of the urinary bladder.
2. Excision of the gallbladder (cholecystectomy).
3. Removal of a cyst.
[cyst- + G. ektomē, excision]
Farlex Partner Medical Dictionary © Farlex 2012

cystectomy

(sĭ-stĕk′tə-mē)
n. pl. cystecto·mies
1. Surgical removal of a cyst.
2.
a. Surgical removal of the gallbladder.
b. Surgical removal of all or part of the urinary bladder.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.

cystectomy

Surgery
1. Excision of the bladder. See Radical cystectomy.
2. Excision of a cyst.
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.

cys·tec·to·my

(sis-tek'tŏ-mē)
1. Excision of the the urinary bladder.
2. Excision of the gallbladder (cholecystectomy).
3. Removal of a cyst.
[cyst- + G. ektomē, excision]
Medical Dictionary for the Health Professions and Nursing © Farlex 2012

cystectomy

Surgical removal of the urinary bladder, usually for cancer. After cystectomy, the ureters, which carry urine down from the kidneys, have to be implanted into the colon or into an artificial bladder made from an isolated length of bowel which drains out through the skin.
Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005
References in periodicals archive ?
The changing pattern of mortality and morbidity from radical cystectomy. BJU International 2000;85:427-30.
The patient was given intravesical mitomycin C and subsequently she underwent radical cystectomy. Examination revealed a microscopic focus of residual tumour in the bladder neck.
Each patient was appointed to visit the hospital on the seventh day and 1st, 3rd, and sixth months after laparoscopic ovarian cystectomy or nonovarian pelvic surgery.
Rogers and her associates propose that dermoid cysts treated with cystectomy should involve a single follow-up visit with an ultrasound 12 months postoperatively.
The data of 263 patients who underwent radical cystectomy for bladder cancer at our clinic between January 1999 and January 2013 were retrospectively analyzed.
Lingual thyroglossal duct cyst with recurrence after cystectomy or marsupialization under endoscopy: Diagnosis and modified Sistrunk surgery.
Usually, following a cystectomy, the urine will have to find another way to get out of the body and would be stored in a pouch outside the body which can be manually emptied.
Gallstones affect about 10% of people in the West- ern World, more than 80% of these people are asymptomatic.2,3 Cholecystectomy is one of the most common operations carried out in general surgery.4 Traditional open cholecystectomy was performed for the first time in 1882 by Carl August Langerbach.4,5 Open cholecystectomy has been accepted as gold standard treatment of gall- stones.6 The change came after 100 years, when in 1987 Professor Mouret from France started with a new operative method of laparoscopic chole- cystectomy.4,7 Laparoscopic cholecystectomy has revolutionized the treatment of gallstone disease and has almost replaced open cholecystectomy.8
The traditional laparotomy can cause large surgical trauma, large amount of bleeding and high risks of postoperative complications such as intestinal adhesion, which may bring great pains to children, and moreover the scar is obvious and the surgical efficacy is not satisfactory.6 Laparoscopic choledochal cystectomy was proposed by Farello et al.7 in 1995.
The study used Natera's Signatera research-use-only test, a personalized, tumor-informed method for detecting molecular residual disease, to evaluate circulating tumor DNA, or ctDNA, in plasma samples collected at diagnosis, during chemotherapy, before cystectomy, and serially during the surveillance period.
Surgical treatment of muscle-invasive bladder cancer (MIBC) as the radical cystectomy is considered to be standard surgical treatment modality.
The company's lead candidate CG0070 has completed an investigation in a Phase 2, single-arm, open-label, multicenter study (BOND2) for patients with NMIBC who failed BCG therapy and refused cystectomy.