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Cystectomy refers to the medical procedure to remove a part or the entire bladder. When bladder cancer spreads to the walls of the bladder, or the cancer has returned after the initial treatment, a cystectomy is usually performed. There are three different types of cystectomy that are used to remove the bladder:

• Simple cystectomy where the entire bladder is removed
• Partial cystectomy where only part of the bladder is removed
• Radical cystectomy where the bladder, nearby affected lymph nodes and organs and parts of the urethra are all removed.

Partial cystectomy is performed when the cancer has invaded only a part of the bladder wall or the cancer cells or tumors are restricted to one area only. Partial cystectomy is also a good treatment option if the cancer does not affect the areas where the urine enters or leaves the bladder. Partial cystectomy is indicated for patients with a normally functioning bladder and a small or solitary tumor that is easily removed.

As compared to simple or radical cystectomy, partial cystectomy also reduces the risk of problems such as impotency in men and early menopause in women. Infertility is another risk that is usually avoided with a partial cystectomy.

Procedure

The procedure of a partial cystectomy is as follows:

• The patient is made to lie in supine position for the procedure and general anesthesia is administered
• A small cut or incision (or a number of small cuts) is made in the lower abdomen
• In most cases, a laparoscope or thin tube is used for this type of surgery
• The laparoscope is fitted with a small camera and light, along with specific surgical tools used in the procedure
• The surgeon is able to see the bladder and the internal organs with the use of the laparoscope
• The surgeon then removes part of the affected bladder and the incision site is stitched close after the procedure
• Since partial cystectomy does not involve the removal of the entire bladder there is no need for the surgeon to create a new way for urine to pass out of the body. In a simple or radical cystectomy, your surgeon connects the ureters to a bag outside the body or even creates a new substitute for the bladder (neobladder)
• The CPT code for a partial cystectomy is 51565

Recovery

After a cystectomy, the patient may need to stay in the hospital for about a week. There will be a certain degree of discomfort after the surgery though this can be managed with the help of painkiller and anti-inflammatory drugs. Complete recovery from the surgery usually takes from six to eight weeks but can vary depending on the overall health of the patient, the amount of bladder removed and the severity of the cancer. To ensure a speedy and safe recovery the patient should:

• Take the appropriate care of the incision site or catheters and drains
• Follow all the surgeon's guidelines such as rules about bathing, swimming, heavy lifting and resuming work
• Drink plenty of water to prevent dehydration and urine odor

If the patient is in the early stages of cancer, immunotherapy may follow a partial cystectomy along with regular follow up care and tests. Patients who have undergone a partial cystectomy need to monitor the progress of the cancer closely. A cystoscopy may be necessary every three month for the next two years. Routine CT scans of the abdomen and pelvis are also suggested in the first couple of years following the procedure.

Complications

Risks and complications associated with a partial cystectomy may include:

• Leakage of urine
• Infection
• Injury to the bladder or urethra
• Excessive bleeding
• Injury or damage to the surrounding organs
• High recurrence rate of tumor
• Urinary extraversion
• Reduced bladder capacity in the long-term

References

• http://www.einstein.edu/einsteinhealthtopic/?articleId=41091&articleTypeId=3&healthTopicid=-1&healthTopicName=HealthSheets

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