Total Cystectomy is surgical removal of all or part of the urinary bladder. Total Cystectomy, also known as Radical Cystectomy is surgical is the removal of the entire bladder, nearby lymph nodes (lymphadenectomy), part of the urethra, and nearby organs that may have been invaded by the cancer cells. In men, the nearby organs that are removed are the prostate, the seminal vesicles, and part of the vas deferens. In women, the cervix, the uterus, the ovaries, the fallopian tubes, and part of the vagina are also removed. The ureters are disconnected from the bladder and urinary diversion is created.
How do I prepare for Total Cystectomy ?
Your surgical team will provide you with instructions about the care of the urostomy opening and the bag. Routine blood and urine analysis, CT of abdomen and chest x-ray will be requested by your physician on your pre-oparative consult. Inform your physician about your other health conditions and medications (including all the prescription, non-prescription medications, nutritional supplements i.e.
vitamins, minerals and herbal products). Refrain from taking aspirin or Ibuprofen at least 2 weeks before Total Cystectomy. Stop smoking a few weeks before Total Cystectomy to prevent healing problems during recovery period. Do not eat or drink anything for at least 10 hours before the Total Cystectomy surgery. You will be instructed to be hospitalized the night before the surgery. You may be given an enema the night before to cleanse your bowel.
What does the procedure for Total Cystectomy involve ?
Total Cystectomy is performed under general anesthesia and may take about 2 - 3 hours. An incision is made across the lower abdomen, the ureters are cut from the bladder, freeing it for removal. The bladder and associated organs i.e. prostate gland, seminal vesicles, vas deferens in men and the uterus, fallopian tubes, ovaries, and part of the vagina in women.
A method of urinary diversion is created to remove the urine (as discussed above) after Total Cystectomy. The tissues and nerves around the prostate and bladder are dissected very carefully to ensure not to damage them (nerve sparing technique) during Total Cystectomy procedure. However, the nerves controlling erection of penis may be damaged during the surgery. In women, your surgeon will reconstruct your vagina after Total Cystectomy.
Total Cystectomy entails surgery to the bladder as well as the bowel. You will spend the next couple of days in the Intensive Care Unit (ICU) under observation following Total Cystectomy. Your vital signs, circulation and respiration will be closely monitored. You will also be closely monitored for any immediate post-operative complications like excessive bleeding. There may be a stoma bag collecting urine that will need to be cared for.
You will notice thin tubes coming out of the urostomy. These are called stents. They will be removed 7-10 days after your Total Cystectomy operation. There will also be a small plastic drain tube from your abdomen that will stay in place for about 5-7 days. You will experience some pain and discomfort which can be alleviated by the use of pain medication. Keep the operation area clean, avoid heavy lifting and sexual activity for 3 - 4 weeks.
You will be able to get back to your normal activities in 2 months time following Total Cystectomy. You will probably be hospitalized for 8 - 10 days after Total Cystectomy procedure. Before going home you will be provided with a follow up regimen that will comprise of Cystoscopy and urinary exams every 3 months for at least 2 years, with regular CT scans of the pelvis and abdomen.
The 5 year survival rate for people who have bladder cancer is 75%. Adjuvant therapy may be needed following a Total Cystectomy which may include radiation therapy, chemotherapy or biological therapy (immunotherapy).
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