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Notes on Operations

Bladder removal - Cystectomy

The bladder is most commonly removed because of bladder cancer. Although the surgery is daunting the outcome is very good with people returning to active lives.

The patient is admitted a couple of days before surgery. They are put on a clear diet and prescribed laxatives to clear out the intestines. The incision runs from just above the pubic bone to just above the belly button. The removal of the bladder is the first step of the procedure. If the bladder is removed obviously the urine needs to be collected somewhere. The traditional method of achieving this is via a bag worn on the abdomen. A length of bowel is used to bring the urine from the kidneys to the surface of the body. This operation in known as cystectomy and ileal conduit.

Newer techniques may be suitable for some patients. It is possible using a number of new operations to create a new bladder within the body. Patients therefore pass their water almost the way that nature intended.

There are a number of drawbacks however. It takes longer to regain control of continence. Although a bag on the abdomen is something all of us wish to avoid, the vast majority of people are able to return to normal activities very speedily. Patients who have had new bladder fashioned may take up to a year and a half to be able to stop worrying that they may leak and indeed some people will leak for ever. In addition a small number of people with new bladders will find that they cannot pass water unaided (particularly the case for women). These patients will need to pass a catheter into the bladder to empty it for the rest of their life. Why with these possible drawbacks do people opt for new bladders? In countries such as Switzerland where the procedure is very common about 50% of people opt for a new bladder. The commonest reason sited for this is to avoid the need for a bag on the abdomen.

How risky is bladder removal?

In the 1970’s as many as 1 in 10 patients undergoing this type of surgery would die from complications. These days in most hospitals the risk is less than 1 in 50. This is predominantly due not to advances in surgery but in post-operative care, for example the provision of high dependency or intensive care beds. The risk for an individual may however be higher, depending of course on other medical problems such as angina, high blood pressure or chest problems.

These risks have to be balanced against the risk of not having treatment. In patients where bladder removal is indicated the risk of death from bladder cancer without radical treatment is approaching 100%.

How long will recovery take?

Patients are in hospital for between two and four weeks after surgery with most people going home just after 2 weeks. There is no doubt that patients feel very tired for 3 months after surgery. It is not until 6 months that life begins to feel as if it is returning to normal.

It is also quite normal to feel depressed after this type of major surgery. It is only when patients return home that this usually sets in. Overnight the patient is transported from the safe and supportive environment of a hospital ward to home, this is accompanied by a degree of stress. At the same time the patient realises just how long it will take to get their strength back. This is experienced by nearly every one but it passes of after a short time.




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