It is widely known that bladder cancer is frequently related to highly aggressive tumors, and has a higher risk of repeated relapses. For this reason, experts often recommend the excision of metastatic organ. This procedure is called a cystectomy. To reduce the chance of relapse, this surgery is often accompanied by the removal, wholly or partly, of nearby organs. For example, women can undergo a partial removal the uterus or vagina, while men can experience the excision of the prostate gland.
One important aspect of operations to remove the bladder is the necessity to create a new urethra so that urine can leave the body. There are several types of cystectomy that accomplish this purpose, and each has its own benefits and risks. Based on the patient’s medical history and his/her current state of health, tumor type, and other essential factors, the physician may recommend a particular type of surgery to remove the bladder.
The most common surgeries include:
Surgery to create a urinary reservoir in the region of the anterior abdominal wall. During this surgery, the surgeon uses colon and small intestine tissue, as well as fragments of the intestinal tube, to create a sac for collecting urine. This sac is then connected to the abdominal wall through a small hole, thus enabling the patient to empty the tank by means of a catheter, which is located on the anterior abdominal wall. The main feature of this method of reconstruction is that the patient does not need to use a urinal constantly.
Urostoma or ileum-conduit surgery. This procedure is the most popular and widely used one. Specifically, it creates a tube of thin fabric or ileum, through which the patient can release urine. Urine from the tube is held in a plastic urinal or container that the patient must carry with them. While this method is considered the most simple, its main drawback is the necessity to constantly carry the container.
Creation of bladder tissue from the small intestine. This type of reconstruction uses fragments of the ileum to form a bladder, which is then connected to the urethra. Thus, the bladder can be emptied simply by contracting the abdominal muscles. This type of surgery may be recommended to patients whose tumor is concentrated away from the opening of the urethra, and near the bladder wall. Patients undergoing this procedure should be aware of the necessity of regular urination, because they lack nerves that would make them feel the urge to urinate. It is especially important to keep this process under control during sleep.
In cases, when control of the process is difficult or impossible for some reason, a catheter can be used for urination. The main benefit of this type of cystectomy is the ability to maintain a healthy way of urination, without having to wear external urinals, which greatly improves the quality of life and the patient's condition after the procedure.