Bladder removal
Bladder removal, or cystectomy, is primarily performed to treat bladder cancer and may involve the complete or partial excision of the bladder. The procedure is typically conducted under general anesthesia, requiring an abdominal incision to sever and tie the ureters, the tubes that carry urine from the bladder. In men, this operation often includes the removal of the prostate gland, while women may also have their uterus, Fallopian tubes, and ovaries excised. Post-surgery, patients must adapt to new ways of managing urine elimination, as a stoma is created to connect the ureters to a section of the small intestine, allowing urine to be expelled from the body.
Cystectomy can lead to significant complications, such as impotence in men and infertility in women, although many women may not be adversely affected due to age-related factors. Other potential issues include infection and challenges with intestinal function. Patients may require the support of enterostomy therapists to navigate the adjustments following the surgery, which can involve learning to manage a stoma or adapting to an internal reservoir known as a neobladder. Overall, cystectomy is a major surgical intervention with lasting implications for patients' lives.
Subject Terms
Bladder removal
Anatomy or system affected: Abdomen, bladder, urinary system
Definition: The surgical removal of the bladder and accompanying structures or organs
Indications and Procedures
Cystectomy (bladder removal) is often the treatment of choice in cases of bladdercancer, which may be treated with chemotherapy or radiation in combination with surgery. The procedure, usually performed under general anesthesia, is carried out by making an incision in the abdomen, after which the ducts that carry urine from the bladder, called ureters, are cut and tied. The affected bladder is removed, and, in men, the prostate gland is also excised. In women, the uterus, Fallopian tubes, and ovaries are removed along with the diseased bladder. Cystectomy may involve only the partial removal of the bladder when possible, and advances in the use of robotics during cystectomy have made the procedure increasingly less invasive.
If an external bag will be used for urine storage, then a permanent opening is made in the abdomen. The two ureters are joined to a tiny section of the small intestine that has been removed from the rest of the intestines, formed into a loop, and inserted through the abdominal wall. Urine is excreted through this opening, called a stoma. If an internal reservoir, called a neobladder, is to be created, then intestinal tissue will be used.
Uses and Complications
A cystectomy has serious consequences. In men, the result is usually impotence because the nerve tracts that permit penile erections are usually damaged severely by the surgery. In women, the outcome is infertility as a result of the combination of cystectomy and hysterectomy. Because most women who undergo the procedure have already experienced menopause, however, this consequence usually does not affect them adversely.
In addition to the complications from infection and systemic shock that can accompany any major surgery, cystectomy poses another problem: following surgery and for the remainder of a patient’s life, either urine must be collected in a pouch that is worn externally, or patients must learn to control the internal neobladder with their abdominal muscles. It takes some patients considerable time to adapt to such complications. Enterostomy therapists teach patients how to care for a stoma; patients are usually referred to these specialists following a cystectomy.
Some patients also experience problems with proper intestinal function in the days immediately following a cystectomy. This difficulty is overcome through the regular administration of a solution of saline fluids and glucose intravenously beginning soon after the surgery.
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