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.

cystectomy

 [sis-tek´to-me]
1. excision of a cyst.
2. excision or resection of the urinary bladder.

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]

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.

cystectomy

Surgery
1. Excision of the bladder. See Radical cystectomy.
2. Excision of a cyst.

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]

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.
References in periodicals archive ?
These data are interesting and suggest a possible advantage to centralizing cystectomies in Alberta to allow for more regular and coordinated multidisciplinary discussion of NACT in MIBC patients.
In situations where ordinal categorical predictors were assessed (number of years since completion of training and average number of cystectomies performed yearly) the Mantel-Haenszel extension test for trend was used, with mid-range values for weights.
Eighteen (70%) participants had been in practice for at least 6 years and 21 (78%) perform greater than 10 radical cystectomies each year (Table 1).
Surgeons who perform more than 40 radical cystectomies per year were less likely to use topical agents for hemostatic control (RR 0.61, 95% CI: 0.38-0.99) and surgeons who have been in practice longer were less likely to use topical agents (Table 4).
Before we can adopt prostate-sparing cystectomies as a routine option for muscle invasive bladder cancer, the potential risk of residual occult cancer in the prostate must considered.
Until further evidence emerges to confirm the oncologic safety and functional benefits of performing prostate-sparing cystectomies, prostate-sparing cystectomy cannot be considered standard of care and should only be carefully considered in highly selected, motivated patients.
While most previous studies have analyzed volume as either a continuous variable or a categorical variable using tertiles/quartiles, Bianchi and colleagues dichotomize annual hospital caseload as greater than 15 or less than 15 cystectomies per year.[sup.10] The cut-point is very high relative to other studies where "high volume" hospitals are usually defined as those that perform >5 to 10 cystectomies per year.[sup.4]-[sup.8] In dichotomizing this outcome and using such a high threshold, Bianchi and colleagues are left with only 12% (n = 1515) of their study population in the high volume group and all of these cases had surgery at academic hospitals.
There are no prospective studies that demonstrate that early cystectomy has a survival benefit[sup.29] and there are obvious quality-of-life issues associated with performing unnecessary cystectomies.