Radical cystectomy is a highly complex surgical procedure indicated for patients with bladder cancer. The surgery can raise concerns for many people, especially due to its impact on quality of life and urinary function, while potentially saving lives.
Advances in medicine have enabled more precise surgical approaches and recovery plans tailored to each patient’s reality, even with changes in urinary function and sexual health.
Keep reading to learn more about the implications and benefits of radical cystectomy for bladder cancer.
What Is Radical Cystectomy and When Is It Indicated?
Radical cystectomy involves the complete removal of the bladder and, in many cases, adjacent structures. In men, this surgery may include the removal of the prostate and the seminal vesicles.
The procedure is mainly indicated for advanced or invasive bladder cancer (when it affects the muscle layer of the organ), or for tumors that recur or do not respond to chemotherapy. Other indications include benign conditions such as refractory interstitial cystitis, severe chronic infections and complex congenital diseases.
What Is the Difference Between Radical Cystectomy and Partial Cystectomy?
The difference lies in the extent of removal:
- Radical cystectomy: complete removal of the bladder and, in some cases, adjacent structures. Patients require a urinary reconstruction.
- Partial cystectomy: removal of only the tumor-affected region, preserving part of the organ and maintaining normal urination.
The choice between one approach or the other depends on the stage of the cancer, the location of the tumor, and the likelihood of recurrence.
Bladder Cancer: Why Might Radical Cystectomy Be Necessary?
Bladder cancer is one of the most common cancers in men – it accounts for more than 3% of male cancers, according to estimates from the National Cancer Institute (Inca) – and can be aggressive if not treated promptly.
Treatment for bladder cancer varies according to the stage of the disease. In addition to chemotherapy and radiotherapy, this surgery may be indicated to help control disease progression, especially in more advanced cases.
The decision to perform the surgery is made after a multidisciplinary assessment in urological oncology.
How Is the Surgery Performed, and What Are the Reconstruction Options?
Radical cystectomy can be performed using different surgical techniques:
- Open surgery: a wide abdominal incision providing direct access for resection and reconstruction.
- Laparoscopic surgery: uses small incisions and minimally invasive instruments.
- Robotic surgery: a minimally invasive approach assisted by a surgical robot.
After the complete removal of the bladder, a strategy must be adopted for a new urinary reservoir. The main options include:
- Ileal conduit: a segment of the small intestine is used to divert urine to a urostomy, which requires an external pouch.
- Orthotopic neobladder: creation of a substitute bladder with intestinal tissue, allowing urination through the natural pathway.
- Urostomy: diversion of urine to an opening in the abdominal skin, where it is collected in an external bag.
How Long Does a Radical Cystectomy Take?
The duration of this surgery ranges from 4 to 8 hours, depending on the technique used for removal and the complexity of the urinary reconstruction.
How Is the Patient Prepared for Radical Cystectomy?
Preoperative preparation for radical cystectomy is a process that involves laboratory tests and imaging studies to assess kidney and liver function, coagulation, and the extent of organ involvement.
It also requires dietary adjustments, such as reducing fiber and adding laxatives, and changes in medications, including suspending anticoagulants and anti-inflammatories to reduce surgical risk.
The preoperative approach may also include psychological support so that the patient understands the consequences of the procedure and is prepared for potential changes after the surgery.
Postoperative Care and Patient Recovery
The postoperative period requires follow-up to minimize complications and ensure an adaptation to the patient’s new urinary reality. Among other measures, it is important to:
- Use prophylactic antibiotics and painkillers;
- Maintain hydration;
- Learn how to manage the neobladder or urostomy, with instructions on hygiene and changing devices;
- Get adequate rest;
- Seek psychological support.
Possible Risks and Complications of Radical Cystectomy
Radical cystectomy carries risks from both the surgery itself and the use of a bag, including hemorrhage, infection, deep vein thrombosis, and healing complications.
To avoid these, it is essential to have medical follow-up and adhere to the guidelines provided by the healthcare professional.
Do You Have to Wear a Bag After Bladder Removal?
The use of a urinary bag may be necessary, depending on the chosen reconstruction technique.
In the case of an orthotopic neobladder, the bag is unnecessary because urine is stored in a reservoir fashioned from a portion of the intestine, allowing the patient to urinate similarly to the natural process.
In the case of ileal conduits and urostomies, however, the bag is essential. Urine is diverted to an opening in the abdominal skin and collected in an external pouch, which must always be worn.
The bag requires specific care to prevent infections and skin irritation.
Can Radical Cystectomy Cause Erectile Dysfunction?
Yes, radical cystectomy can affect the neurovascular structures essential for erection and cause erectile dysfunction, which is one of the main concerns among men requiring this treatment.
This mostly happens when the prostate and seminal vesicles are removed. In some surgeries, the nerves are affected because they are very close to these structures, which can lead to partial or total loss of erection.
Additionally, factors such as hormonal changes, psychological impact, and altered blood flow can also contribute to this condition.
There are treatments that can help men who experience this issue. Penile rehabilitation can begin soon after surgery, using medications like Sildenafil or Tadalafil, as well as physiotherapy and vacuum devices, depending on the urologist’s recommendation. In severe cases, penile prostheses may be recommended.
The Importance of Detecting Bladder Cancer Early
Early diagnosis of bladder cancer can increase the chances of successful treatment and reduce the need for more aggressive interventions, such as radical cystectomy.
Identifying the disease in its early stages allows for less invasive therapeutic options that do not require removal of the entire organ. For this reason, symptoms like blood in the urine, painful urination, and increased urinary frequency should not be ignored, as they may indicate early stages of the disease.
Radical cystectomy is a complex intervention that can often be avoided with early diagnosis, helping reduce impacts on quality of life and sexual function. To learn more about maintaining your health, rely on the expertise of Dr. Paulo Egydio and check out more tips on the blog.
