Around 70 % of bladder cancer patients are initially diagnosed at an early stage of the tumor. A careful diagnosis is then made. If it is then established that the tumor has not yet infiltrated the urinary bladder muscles, patients often receive radiotherapy and/or chemotherapy first.
A simple bladder removal may also be possible instead of radical removal.
For radical cystectomy, the timing of the operation is crucial:
- all other options for treating the bladder cancer must have been exhausted, but
- the cancer must not have metastasized to other organs.
To be on the safe side, the surrounding organs and nearby lymph nodes are also removed together with the bladder.
The following clinical pictures speak in favor of radical bladder removal:
- Muscle-invasive carcinoma of the bladder: In this case, the tumor has already infiltrated the muscle layer of the bladder wall and possibly surrounding tissue, but not yet more distant tissue.
- Superficial bladder carcinoma with an aggressive growth tendency: This is a non-muscle-invasive bladder cancer that nevertheless shows rapid and uncontrollable growth.
- Minimally invasive, difficult-to-access superficial bladder cancer: Transurethral resection (endoscopic resection via the urethra, also known as TURB) cannot control this form of cancer.
- As a palliative measure: If an inoperable bladder carcinoma leads to increased pain, bleeding and other symptoms that restrict the quality of life, a radical cystectomy is also indicated.
- Non-existent bladder capacity: Bladder shrinkage can severely restrict bladder capacity. This results in constant urge incontinence, which greatly reduces the quality of life of those affected.
The position of the bladder, which is connected to the kidneys via the ureters © pixdesign123 | AdobeStock
You will need to be admitted as an inpatient for the operation. This means that you will be given a bed in hospital and will remain in the clinic for a few days after the operation.
You will also have a consultation beforehand. The attending doctor will inform you about the surgical technique and possible risks. You will also be informed in detail about the alternatives to urinary diversion before the operation.
The patient is usually in the supine position and under general anesthesia during the operation.
For the radical cystectomy, the surgeon opens the abdomen from the pubic bone to the navel. He first removes the bladder and the lymph nodes, as these could be contaminated by metastases.
As part of the radical cystectomy, the surgeon also removes - depending on gender - the prostate or
In this condition, the body can no longer drain the urine produced in the kidneys. The surgeon therefore constructs an artificial urinary diversion or urinary bladder so that urine can be drained even after the operation.
The procedure takes between three and five hours.
As an alternative to the conventional surgical method, a minimally invasive surgical technique may also be considered. An operation is performed as part of a laparoscopy using an assisting surgical robot(Da Vinci). Surgical instruments including a video camera are inserted through the abdominal wall using tiny incisions in the skin.
This robot-assisted, minimally invasive bladder removal is considered a major challenge with a high degree of difficulty. Nevertheless, the advantages of this method outweigh those of open abdominal surgery:
- There is significantly less blood loss,
- the surgical wounds heal much faster,
- there are fewer complications and
- there is less scarring.
However, not every clinic is equipped accordingly or offers this rather cost-intensive surgical technique. You should clarify the question of whether a Da Vinci operation is possible for you with your doctor in advance.
Depending on the findings and the course of the operation, another form of artificial urinary diversion may be considered after a radical cystectomy. Of course, your wishes or dislikes with regard to certain forms of urinary diversion will also be taken into account.
There are 3 options for the artificial drainage of urine:
- Wet or incontinent urinary diversion: with this method, the urine flows from the abdominal cavity directly into a bag, which cannot be seen by others. This form of urinary diversion is particularly advisable if the disease has severely impaired the patient's general condition.
- Dry urinary diversion: The surgeon removes part of the small intestine, sometimes also a piece of the large intestine, and constructs a replacement bladder from it. This new bladder is called a "neobladder" in medicine. The prerequisites are intact ureters, a good general condition and a healthy bowel.
- Dry urinary diversion via the skin: In cutaneous urinary diversion (via the skin), the surgeon also constructs a urine reservoir in the abdomen from parts of the bowel. This urinary reservoir, known as a pouch, extends to the area around the navel. A kind of valve is inserted there to drain the urine. If the pouch fills up and presses on the artificial outlet, you can empty the pouch with a disposable catheter. This type of "abdominal urinary bladder" is called a continent or dry urostomy, as you can control the emptying yourself.
If a neobladder is used, the patient can use the toilet as usual without any problems. The only problem is that the patient does not feel when the neobladder is full. They must therefore get into the habit of emptying their bladder on the toilet at regular intervals (every 3 to 4 hours). Then the missing bladder will soon no longer be a problem in everyday life.
The urine does not pass by itself when you urinate. You must therefore use your abdominal muscles to press. If you still have difficulties emptying your bladder, you can use a catheter to drain the urine.
You will also learn how this works and how to insert the catheter after your operation.
Aftercare takes place either in the hospital where the operation was performed. However, it can also be provided by a urologist in private practice with the relevant experience.
A radical cystectomy initially presents those affected with a major psychological challenge. However, thanks to state-of-the-art technology, patients can now lead an almost normal life again with both a neobladder and an artificial urinary outlet.
