Cystectomy is the surgery to remove the bladder under general anesthesia. It involves the establishment of a bypass system to evacuate urine. This intervention is performed for the treatment of certain cancers, or in certain patients suffering from a neurological disease or undergoing heavy treatments which alter the functioning of the bladder. After a cystectomy, urinary functions, sexuality and fertility are impaired.

Cystectomy is the surgery to remove the bladder. The surgery can be performed by laparotomy (incision below the navel) or by laparoscopic surgery with or without robotic assistance. It usually involves the removal of the prostate in men, and the uterus in women.

In all cases, it involves the establishment of a bypass system to replace the bladder and evacuate the urine produced by the kidneys.

Three types of derivation are possible:

• The ileal neo-bladder, considered if the urethra (tube that allows urine to be evacuated) can be kept: the surgeon builds an artificial bladder from a piece of intestine that he shapes into a reservoir . It then connects this pocket to the ureters (tubes that carry urine from the kidneys) and the urethra. This neo-bladder allows the evacuation of urine by natural means;
• The cutaneous continent bypass: the surgeon builds an artificial bladder from a piece of intestine that he shapes in the form of a reservoir. He then connects this bag to a tube connected to an orifice at the level of the skin which allows the patient to perform regular manual emptying;
• The uretero-ileal bypass according to Bricker: the surgeon removes a segment of the intestine that it connects to the kidneys through the ureters and that it connects to the skin near the navel. The end of the segment forms a visible opening on the abdomen which serves as a support for an external pocket fixed against the body in which urine constantly flows. The patient should empty and change this bag regularly.

Preparing for a cystectomy

This intervention requires preparation, in particular for more fragile patients (cardiac history, anticoagulants, diabetes, etc.) During the 10 days preceding the operation, the patient must follow the usual advice given by the surgical team: rest , light food, stop smoking, no alcohol …

The intestine is likely to be used during the procedure for the placement of a bypass system. It must therefore be prepared by a residue-free diet to start a few days before the operation.

The day before the intervention

The patient enters the hospital the day before the operation. He must ingest a liquid which allows the intestine to empty.

The different stages of a cystectomy

• The anesthesiologist places an epidural catheter under local anesthesia to control pain after the operation. Then he puts the patient to sleep completely;
• The surgeon removes the bladder (and often the prostate and uterus) by laparotomy or laparoscopic surgery;
• He then sets up a urinary bypass for the elimination of urine.

In the event of a cystectomy for cancer, the removal of the bladder is associated with:

• In men, lymph node dissection (surgery to remove all lymph nodes from the area where cancer is likely to have spread) and removal of the prostate;
• In women, lymph node dissection and removal of the anterior wall of the vagina and uterus.

• Cystectomy is the standard treatment for cancers that have affected the muscle of the bladder, the most severe form of bladder cancer;
• Cystectomy may be prescribed for bladder cancer that has not reached the muscle in the event of cancer recurrence despite tumor resections (removal of the tumor from the organ) and drug treatment prescribed as the first line;
• Finally, the ablation of the bladder can be considered in certain patients suffering from a neurological disease or undergoing heavy treatments (radiotherapy) which alter the functioning of the bladder.

The days following the operation

• The patient is placed in intensive care so that the medical team can control the pain (epidural catheter), urinary function (blood tests), the proper functioning of the leads and the resumption of transit;
• The urine is drained by catheters, and the operated area is drained by exteriorized drains on either side of the abdominal incision;
• The team ensures that the patient regains autonomy as quickly as possible;
• The duration of hospitalization is at least 10 days.

Risks and complications

Complications can appear in the days following the operation:

• Bleeding;
• Phlebitis and pulmonary embolism;
• Infections (urinary, lining, scar or generalized);
• Urinary complications (dilation of the intestinal bladder, narrowing at the level of the suture between the intestine and the urinary ducts, etc.);
• Digestive complications (intestinal obstruction, stomach ulcer, etc.)

Side effects

Cystectomy is an intervention that has sequelae on urinary and sexual functions:

• Sexuality and fertility are impaired;
• In men, removal of the prostate leads to a loss of certain erection mechanisms;
• Continence (ability to control the emission of urine) is greatly modified;
• At night, patients must wake up to empty the bladder and avoid leaking.