Bladder surgery

Overview

Cystectomy, a surgical procedure to remove the urinary bladder, is part of bladder surgery. This surgery addresses conditions related to the urinary bladder, the organ located below the kidneys and above the urethra, responsible for storing urine. The choice of bladder surgery depends on the specific condition being treated. Surgical interventions may be required for conditions such as:

• Bladder cancer
• Cystocele (fallen bladder/bladder prolapse)
• Urinary incontinence (loss of bladder control)

Types

Bladder surgeries have evolved, with a shift towards robotic procedures involving minimal incisions and the use of robotic arms. Open surgeries with long cuts are becoming less common. Various types of bladder surgeries include:

• Bladder exstrophy repair: Corrects a birth defect where the bladder is inside out and adhered to the abdominal wall.
• Anterior repair: Addresses severe cystocele (bladder prolapse) by making an incision in the vaginal wall, tightening the tissue separating the bladder and vagina. Permanent mesh grafts may be used for additional vaginal support.
• Urostomy: In cases of bladder loss, a segment of the intestine is reattached to the ureters, directing urine to a stoma near the belly button. A leak-proof bag collects urine, which can be emptied as needed.
• Neobladder urostomy: Forms a pouch or neobladder using a segment of the intestine. Placed in the cavity left by the bladder, it allows for voluntary drainage without the need for external bags. The neobladder may be connected to the urethra for normal urine drainage.

Bladder cancer is a common reason for surgery, and depending on its stage, various procedures may be employed, including:

• Radical cystectomy: Completely removes the bladder through an abdominal incision. Adjacent organs are examined for cancer spread, and affected organs are removed.
• Segmental or partial cystectomy: Removes a portion of the bladder, suitable for low-grade tumors limited to one area. This preserves normal urination while reducing bladder size.
• Transurethral resection (TUR) with fulguration: Involves inserting a cystoscope through the urethra to remove or burn cancer using high-energy electricity (fulguration).
• Urinary diversion: Ceates a new method for storing and passing urine.

These surgeries play a crucial role in treating bladder cancer, often combined with chemotherapy or radiation therapy for comprehensive care.

Reasons for undergoing the procedure

Your healthcare provider might suggest cystectomy as a treatment for:

• Cancer originating in or spreading to the bladder
• Congenital irregularities in the urinary system
• Neurological or inflammatory disorders impacting the urinary system

The specific type of cystectomy and reconstruction recommended will be influenced by factors like the underlying reason for surgery, your overall health, and your preferences and care requirements.

Risk

Bladder surgery is a complex surgery and complications are possible. Patients who are over 60 or who were born as female are more vulnerable. The possible risks include the following:

• Infection
• Bleeding
• Blood clots in the legs
• Blood clots at the lungs or heart
• Poor wound healing
• Injury to surrounding tissues or organs
• Organ damage as a result of sepsis, the body’s reactivity to an infection

There are several consequences that could be life-threatening or necessitate hospitalization. The patient might require more surgery to resolve the complications.

Procedure

The types of procedures used to do bladder surgery are as follows.

• Open surgery: This method allows access to the bladder and pelvic through a single abdominal incision.
• Minimally invasive surgery: During minimally invasive surgery, the abdominal cavity is accessed by the surgeon making multiple small incisions in the abdomen through which specific surgical instruments are placed. Another name for this kind of procedure is laparoscopic surgery.
• Robotic surgery: One kind of minimally invasive surgery is robotic surgery. The surgeon uses robotic surgical instruments from a distance while seated at a console.

Before the procedure

Your healthcare provider may advise discontinuing certain medications that pose a bleeding risk during your bladder surgery. It is recommended to stop the following medications approximately one week before the procedure:

• NSAIDs, such as:
  • Ibuprofen
  • Naproxen
• Blood thinners, including:
  • Warfarin
  • Clopidogrel
  • Acetylsalicylic acid (Aspirin)

Additionally, some antibiotics, blood pressure medications, herbal medications, or supplements may also be restricted. Smoking and tobacco product use should be stopped, as they can heighten risks during and after surgery, slowing down the healing process and compromising the immune system.

It is essential not to discontinue any medication without explicit instructions from your healthcare provider.

Your provider is likely to recommend dietary changes the day before the surgery, and you may be advised to follow a clear liquid diet starting the morning of the surgery. Arranging for post-surgery care is crucial, as immediate return to normal activities is not recommended.

During the procedure

Bladder surgeries vary based on the specific condition being treated, with each requiring a unique approach. It is crucial to discuss the details with your healthcare provider to ensure a clear understanding and comfort with the proposed procedure. In contemporary practice, many bladder surgeries are performed using robotic techniques, replacing traditional “open” surgery with a few smaller incisions. This approach minimizes healing time, lowers risk factors, and reduces scarring, offering a more advanced and patient-friendly surgical option.

After the procedure

The recovery process following bladder surgery is highly dependent on the specific type of procedure undergone. For instance, a transurethral resection involves minimal tissue alteration compared to a radical cystectomy, which entails the complete removal of the bladder. Consequently, the duration and nature of recovery can vary. Your healthcare provider will play a crucial role in guiding you through this process, which may include a voiding trial to assess your ability to urinate post-surgery, along with instructions for catheter care.

After the surgery, it is important to schedule follow-up appointments with your healthcare provider for a thorough examination. Any issues or concerns that have arisen since the procedure should be promptly reported. In cases of bladder cancer, your healthcare provider may need to perform a bladder examination using a camera to ensure proper monitoring.

Outcome

Recovery time after bladder surgery varies depending on the specific procedure; consult your healthcare provider for personalized guidance. Avoid strenuous activities, exercise, and heavy lifting for at least a few weeks post-surgery. Ensure adequate fluid intake to prevent urinary tract infections.

Your healthcare provider will prescribe pain medications, and inquire about any other necessary medications before leaving the hospital. Contact your surgeon if you experience severe pain, inability to urinate, fever, or blood in your urine.

Report symptoms of bladder cancer, such as hematuria (blood in urine), urgent or frequent urination, pain during urination, or discomfort in the lower abdomen or back, to your healthcare provider.