What is Cystectomy?

Cystectomy is a surgical procedure involving the partial or complete removal of the urinary bladder. It's a major surgery typically recommended when other treatments for bladder-related conditions have proven ineffective or aren't viable options. The extent of the surgery, whether partial or complete, depends on the underlying medical condition and its severity. A cystectomy can significantly improve the quality of life for patients suffering from debilitating bladder conditions and, in the case of cancer, potentially offer a cure.

The decision to undergo a cystectomy is a complex one that requires careful consideration and consultation with a qualified medical team. Patients should have a thorough understanding of the procedure, its potential benefits, risks, and alternative treatment options. In India, with its diverse healthcare landscape, it's crucial to seek guidance from experienced surgeons and hospitals equipped to handle complex urological procedures. The long-term implications of cystectomy, especially regarding urinary diversion, also warrant a detailed discussion.

Key Facts:

• Cystectomy involves the surgical removal of all or part of the bladder.
• It's often a treatment for bladder cancer, but can also be used for other severe bladder conditions.
• Following a total cystectomy, a new way to pass urine is surgically created (urinary diversion).
• Recovery can take several weeks or months.

Why is Cystectomy Performed?

Cystectomy is primarily performed to treat bladder cancer, but it can also be necessary for other severe bladder conditions.

Main Conditions/Indications:

• Muscle-invasive Bladder Cancer: When cancer has spread into the muscle wall of the bladder.
• Non-muscle-invasive Bladder Cancer: In cases where the cancer is recurrent or unresponsive to other treatments like BCG therapy.
• Severe Bladder Infections: Chronic or severe infections that damage the bladder.
• Interstitial Cystitis: A chronic bladder condition causing pain and frequent urination, when other treatments fail.
• Congenital Abnormalities: Birth defects affecting the bladder's structure or function.
• Other Urinary Tract Disorders: Conditions that severely compromise bladder function and quality of life.

When Doctors Recommend It:

Doctors typically recommend cystectomy when:

• Cancer has invaded the bladder muscle layer.
• Non-invasive bladder cancer persists or recurs despite other treatments.
• The bladder is severely damaged or dysfunctional due to other conditions.
• Other treatments have failed to provide relief or are not suitable for the patient.

Preparation for Cystectomy

Preparing for a cystectomy is crucial for a successful outcome. It involves several steps to ensure the patient is in the best possible condition for surgery.

Essential Preparation Steps:

• Medical Evaluation: A comprehensive assessment of your overall health, including blood tests, urine tests, ECG, and imaging scans (CT scan, MRI).
• Medication Review: Inform your doctor about all medications, including over-the-counter drugs and supplements. Some medications, like blood thinners, may need to be stopped before surgery.
• Bowel Preparation: You may be required to follow a bowel preparation regimen to clear your intestines before surgery. This often involves a special diet and laxatives.
• Dietary Restrictions: You will likely need to follow a clear liquid diet for 24 hours before surgery.
• Smoking and Alcohol Cessation: If you smoke, quit as soon as possible before surgery. Avoid alcohol for at least a week before the procedure.
• Physical Activity: Maintain a moderate level of physical activity as advised by your doctor to improve your overall fitness.
• Consultations: Meet with the surgeon, anesthesiologist, and other members of the medical team to discuss the procedure, anesthesia options, and potential risks.
• Pre-operative Education: Attend any pre-operative education sessions provided by the hospital to learn about what to expect during and after surgery.

India-Specific Tips:

• Fasting: Follow your doctor's instructions regarding fasting before surgery. It is crucial to adhere to these guidelines to prevent complications during anesthesia.
• Documents: Ensure you have all necessary medical records, identification documents (Aadhar card, PAN card), and insurance information ready for admission.
• PCPNDT Act: If you are a woman undergoing a radical cystectomy that includes removal of reproductive organs, be aware of the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, which prohibits sex selection. Your doctor will ensure compliance with this law.
• Second Opinion: Don't hesitate to seek a second opinion from another qualified urologist, especially if you have any doubts or concerns.
• Hospital Selection: Choose a reputable hospital with experienced surgeons and a well-equipped urology department. Consider factors like accreditation, patient reviews, and available technology.

What to Expect:

• You will be admitted to the hospital a day or two before surgery.
• The medical team will perform final checks and answer any remaining questions.
• You will be given instructions on how to prepare for surgery, including showering with antibacterial soap.
• You will meet with the anesthesiologist to discuss the anesthesia plan.
• Be prepared for a hospital stay of approximately 7-10 days, depending on the type of surgery and your recovery progress.

The Cystectomy Procedure

The cystectomy procedure involves removing all or part of the bladder. The specific approach depends on the underlying condition, its severity, and other individual factors.

Step-by-Step (Concise):

1. Anesthesia: You will receive general anesthesia to ensure you are unconscious and pain-free during the procedure.
2. Incision: The surgeon makes an incision in the abdomen. The size and location of the incision depend on whether it is an open, laparoscopic, or robot-assisted cystectomy.
3. Bladder Removal: The surgeon carefully removes the bladder, either partially (partial cystectomy) or completely (radical or total cystectomy).
4. Lymph Node Dissection: Lymph nodes in the surrounding area are often removed to check for cancer spread.
5. Organ Preservation (if possible): The surgeon takes care to preserve nearby organs, such as the prostate in males or the uterus in females, whenever possible.
6. Urinary Diversion: After bladder removal, a new way for urine to exit the body is created. This can be done through:
   • Ileal Conduit: A section of the small intestine is used to create a conduit for urine to flow to a stoma on the abdomen, where it is collected in a bag.
   • Neobladder: A new bladder is constructed from a segment of the intestine and connected to the urethra, allowing you to urinate naturally.
   • Continent Cutaneous Reservoir: An internal pouch is created from a section of the intestine with a valve that prevents leakage. The pouch is emptied by inserting a catheter through a small opening on the abdomen.
7. Closure: The incision is closed with sutures or staples.

Duration, Comfort Level:

• The surgery typically takes 4-8 hours, depending on the complexity of the procedure and the type of urinary diversion.
• You will likely experience pain after surgery, which will be managed with pain medication.
• The comfort level will gradually improve as you recover.

What Happens During the Test:

• You will be under general anesthesia and will not feel any pain during the procedure.
• The surgical team will monitor your vital signs throughout the surgery.
• After the surgery, you will be transferred to the recovery room and then to your hospital room.

Understanding Results

The results of a cystectomy primarily relate to the extent of cancer removal and the success of the urinary diversion.

What Results Mean:

• Pathology Report: A pathologist examines the removed bladder tissue and lymph nodes to determine the type and stage of cancer, as well as whether the cancer has spread.
  • Clear Margins: Indicates that all visible cancer was removed during surgery.
  • Positive Margins: Indicates that cancer cells were found at the edge of the removed tissue, suggesting that some cancer may still be present.
  • Lymph Node Involvement: Indicates that cancer has spread to the lymph nodes.
• Urinary Diversion Function: Assessment of how well the urinary diversion is functioning.
  • Ileal Conduit: Monitoring for stoma complications, urine leakage, and kidney function.
  • Neobladder: Assessing bladder capacity, continence (ability to hold urine), and ability to empty the bladder completely.

Next Steps:

• Adjuvant Therapy: If the pathology report indicates a high risk of recurrence, your doctor may recommend additional treatments such as chemotherapy or radiation therapy.
• Follow-up Appointments: Regular follow-up appointments with your urologist are essential to monitor for recurrence and manage any potential side effects of surgery.
• Lifestyle Modifications: You may need to make lifestyle changes, such as dietary adjustments and exercise, to improve your overall health and recovery.
• Rehabilitation: Depending on the type of urinary diversion, you may need rehabilitation to learn how to manage your new bladder function. This may include learning how to catheterize yourself or manage a stoma.

Costs in India

The cost of cystectomy in India can vary significantly depending on several factors.

Price Range in ₹ (Tier-1, Tier-2 Cities):

• Tier-1 Cities (Mumbai, Delhi, Bangalore, Chennai, Kolkata, Hyderabad): ₹ 1,50,000 to ₹ 7,50,000
• Tier-2 Cities (Pune, Ahmedabad, Jaipur, Lucknow, Coimbatore): ₹ 1,00,000 to ₹ 5,00,000

Government vs. Private:

• Government Hospitals: Cystectomy procedures are generally more affordable in government hospitals, with costs ranging from ₹ 50,000 to ₹ 2,00,000. However, waiting lists may be longer, and the availability of advanced technologies like robotic surgery may be limited.
• Private Hospitals: Private hospitals offer more comprehensive services, advanced technologies, and shorter waiting times, but the cost is significantly higher.

Insurance Tips:

• Check Coverage: Before undergoing surgery, check with your insurance provider to understand the extent of coverage for cystectomy procedures, including pre- and post-operative care.
• Pre-authorization: Obtain pre-authorization from your insurance company to ensure that the surgery is covered.
• Cashless Option: Inquire about the availability of cashless treatment at the hospital you choose.
• Government Schemes: Explore government health insurance schemes like Ayushman Bharat, which may provide financial assistance for cystectomy procedures.

How Ayu Helps

Ayu helps you manage your health information seamlessly.

• Store Results Digitally: Securely store your cystectomy-related medical records, including pathology reports and imaging scans, in one place.
• Track Over Time, Share via QR: Monitor your health trends over time and easily share your medical history with doctors using a QR code.

FAQ

Q: What is the success rate of cystectomy for bladder cancer?

A: The success rate depends on the stage of cancer and the patient's overall health. Five-year survival rates generally range from 50% to 70%. Early detection and the absence of metastasis improve outcomes.

Q: How long does it take to recover from a cystectomy?

A: Recovery time varies depending on the type of surgery (open, laparoscopic, robotic) and the individual's overall health. Laparoscopic cystectomy typically takes 1-3 weeks, while open cystectomy may require several weeks or months.

Q: What are the long-term side effects of cystectomy?

A: Potential long-term side effects include urinary problems, bowel problems (if a neobladder is created), sexual dysfunction, and complications related to the urinary diversion.

Q: Will I be able to live a normal life after a cystectomy?

A: Yes, most patients can live a fulfilling life after a cystectomy. With proper management and lifestyle adjustments, you can adapt to the changes in bladder function and maintain a good quality of life.

Q: What is the difference between an ileal conduit and a neobladder?

A: An ileal conduit is a simple urinary diversion where urine flows through a section of the small intestine to a stoma on the abdomen, where it is collected in a bag. A neobladder is a new bladder constructed from a segment of the intestine and connected to the urethra, allowing you to urinate naturally.

Q: How often will I need to follow up with my doctor after a cystectomy?

A: Follow-up appointments are typically scheduled every 3-6 months for the first two years, then annually thereafter. The frequency may vary depending on your individual situation.

Q: Is robotic cystectomy better than open cystectomy?

A: Robotic cystectomy offers several advantages over open cystectomy, including smaller incisions, less pain, faster recovery, and reduced blood loss. However, it may not be suitable for all patients, and the availability of robotic surgery may be limited in some hospitals. The best approach depends on individual factors and the surgeon's expertise.