Almost any health issue you can think of, there is likely a procedure or medication to cure it, or at the very least relieve symptoms and allow those suffering to have a better quality of life. Of course, we’re not talking about medical mysteries that make the Nightly News, but even illnesses and diseases that are considered life-threatening with a bleak survival outlook, like certain cancers or diseases such as coronary artery disease (CAD), have options for patients to ease their pain. Surgical procedures have been used to help those diagnosed with all kinds of cancers to remove tumors, cancerous cells, or even the entirety of the affected tissue, like women who have received a mastectomy, or the removal of the entire breast in the case of a breast cancer diagnosis. Of course, there are numerous kinds of procedures that can take place to remove affected tissue, but the procedure name and techniques used depend on the location of the tumor. If diagnosed with bladder cancer, a cystectomy may be recommended. But what exactly is that, and how is it done?
What is a Cystectomy?
The definition of a cystectomy according to the Mayo Clinic, is “a surgery to remove the urinary bladder.” This procedure is often done to control the spread of bladder cancer. In a report from 2011, it was estimated that approximately 70,000 people in the United States will be diagnosed with bladder cancer, and approximately 25% of them will eventually need to have their bladders removed to control the cancer. While both men and women can be diagnosed with bladder cancer, men are three times as likely to develop it than their female counterparts, according to UCLA Health. Much like other procedures that remove internal organs or tissue, one may undergo a partial cystectomy, or a radical cystectomy, to remove part of or the entirety of the bladder.
Partial Cystectomy – Only a part of the bladder is removed. Usually, nearby lymph nodes are removed as well to determine whether any cancer has spread beyond the bladder. The remaining bladder is repaired and stays in the body.
Radical Cystectomy – This is the removal of the entire bladder and nearby lymph nodes. In men, surgeons almost always cut the vas deferens and remove the prostate and seminal vesicles. In women, doctors often also remove the uterus, fallopian tubes, ovaries, cervix and occasionally part of the vaginal wall.
While these kinds of surgical procedures are normally done for those with bladder cancer, it may be used to treat other pelvic tumors (advanced colon, prostate or endometrial cancer). Beyond a cancer diagnosis, a cystectomy may be performed for those with birth defects or neurological or inflammatory disorders that affect the urinary system.
Types of Procedures
Both a radical and partial cystectomy involves some type of surgical procedure. There are two types that may be performed to remove a part, or all, of the bladder. According to the Cleveland Clinic, the following may be done:
Open cystectomy: Your surgeon accesses your bladder and the tissues around it with one long incision in your abdomen. The surgeon’s and assistant’s hands enter the body cavity to perform the operation.
Minimally invasive (laparoscopic or robotic) cystectomy: The abdomen is first insufflated with carbon dioxide to create working space for your surgeon. Very small incisions are made so that long instruments can be inserted into the body cavity to perform the operation. The surgeon’s and assistant’s hands do not enter the body cavity. Laparoscopic cystectomy involves the surgeon and assistant using these instruments directly. Robotic cystectomy involves attaching the instruments to a surgical robot so that the surgeon can control the instruments via a surgical console. The surgical robot enhances the operation by providing three-dimensional vision and increasing instrument dexterity.
For those that have the entirety of the bladder removed, the surgeon must also reconstruct the urinary tract in one of three ways (Ileal conduit, continent cutaneous diversion, or neobladder) so that the urine you produce can be eliminated from your body.
Cystectomy & Urinary Incontinence
Naturally, like any surgical procedure, there are risks that come along with undergoing a cystectomy. Infections can occur at almost any point during surgery or in recovery, both internally and in or around the incisions. In addition, cystectomies could have various other complications that could arise short-term or in the long-term like small-bowel obstruction and ureteroenteric stricture. Another complication that may come about post-procedure is Stress Urinary Incontinence, or SUI. SUI is the accidental bladder leaks that are triggered by slight pressure or “stress” on the bladder or urinary tract, usually through common activities like sneezing or laughing. In one report, it was found that urinary incontinence is a problem for those who have received a cystectomy.
“The incidence of incontinence following this surgery is reported to be 30-60% and is – despite a better understanding of the male (and female) pelvic anatomy – still regarded as an adverse outcome of this surgery.”
Thankfully, there are numerous options for those suffering from light bladder leaks, regardless of what caused them. Bladder support devices like Revive® can be found over-the-counter and are designed to improve the quality of life by preventing them from happening for up to 12 hours a day.