Bladder removal surgery is a surgical procedure used to remove all or part of the bladder, primarily for the treatment of bladder cancer or other severe bladder diseases. This operation can thoroughly eliminate malignant tumor tissue, prevent the spread of cancer cells, and may require reconstruction of the urinary system to restore urination function. Depending on the severity of the condition, the scope of surgery may include surrounding lymph nodes or related organs.
This therapy is commonly performed in patients with advanced bladder cancer, especially when tumors have invaded the muscular layer of the bladder or are unresponsive to other treatments. Surgeons will evaluate the necessity of this procedure. Postoperative treatment may include chemotherapy or radiation therapy to improve overall efficacy.
Bladder removal surgery mainly falls into three types: total cystectomy (removal of the entire bladder), partial cystectomy (removal of only part of the tissue), and extended cystectomy (including surrounding tissues and lymph nodes). Surgical approaches can be open surgery (via a large incision) or minimally invasive techniques such as laparoscopy or robot-assisted surgery.
Robot-assisted surgery utilizes high-resolution imaging and precise instruments, allowing for more accurate tissue removal and reduced tissue damage. Postoperative reconstruction of the urinary tract is usually necessary, such as creating an ileal conduit or a continent reservoir, to restore urination function.
Main indications include:
The surgery typically requires general anesthesia, with a duration ranging from 6 to 12 hours depending on the extent. Patients need to stay hospitalized for 7 to 14 days for recovery, with regular follow-up for tumor markers and imaging tests. If urinary reconstruction is performed, patients will learn to use urinary bags or new urination systems.
Main benefits include:
Postoperative urinary reconstruction options can provide patients with a better quality of life, with some methods even preserving near-normal urination functions.
Main risks include:
Minimally invasive procedures reduce infection risk, but complex reconstructions may increase operative time and complication rates. Long-term follow-up shows that about 5-10% of patients may experience chronic pain or urinary strictures.
Contraindications include:
Preoperative assessment should include detailed evaluation of renal and cardiopulmonary function, along with comprehensive imaging to confirm whether cancer has metastasized. Postoperative care requires strict adherence to nursing instructions, avoiding heavy lifting or vigorous activity for at least six weeks.
This surgery is often combined with neoadjuvant chemotherapy, which can shrink the tumor before surgery. Patients who have received radiation therapy may have increased tissue fibrosis, complicating surgical procedures.
According to U.S. cancer registry data, patients with localized bladder cancer who undergo radical cystectomy have a 5-year survival rate of 60-70%. A 2018 study in the New England Journal of Medicine indicated that robot-assisted surgery reduces the risk of central nervous system metastasis by 34% and shortens hospital stay by 2.5 days compared to traditional open surgery.
Alternative treatments include:
However, these alternatives may not completely eliminate the tumor and are generally suitable for early-stage or high-risk surgical patients. The choice of treatment depends on tumor staging and the patient’s overall health condition.
Patients should undergo comprehensive evaluations of cardiovascular and respiratory functions, as well as tumor extent assessments. Discussions with the surgeon about urinary diversion methods (such as ileal conduit or urostomy) are essential. Three days before surgery, bowel cleansing and antibiotic prophylaxis may be required to prevent infection. Nutritional planning for postoperative diet should also be discussed with a dietitian.
After urinary diversion surgery, how should one cope with potential urination issues?If a urostomy is performed, patients need to learn how to use and regularly change urostomy bags to prevent infections. For ileal neobladder, patients must adapt to the new urination pattern, which may involve catheterization training or periodic bladder dilation. The surgeon will provide individualized plans for restoring urination function.
What dietary or activity restrictions should be observed long-term after total cystectomy?Patients should limit high-fiber foods to reduce the risk of bladder outlet obstruction and increase fluid intake to prevent urinary stones. Heavy lifting or vigorous exercise should be avoided for at least three months to prevent suture dehiscence. Regular monitoring of serum potassium levels is recommended, as the ileal conduit may affect electrolyte balance.
What is the recommended frequency and scope of postoperative follow-up examinations?During the first year, follow-up should include urine tests, imaging, and tumor marker assessments every 3-6 months. Afterward, annual check-ups are advised. Immediate medical attention is necessary if symptoms such as urination pain, fever, or abnormal stoma discharge occur, indicating possible infection or obstruction.
What factors influence the success rate of total cystectomy?Early diagnosis (such as cancer confined to the superficial layers) results in a 5-year survival rate exceeding 70%. Neoadjuvant chemotherapy before surgery and complete (R0) resection significantly improve success rates. Postoperative adherence to follow-up and lifestyle adjustments are also crucial factors for successful outcomes.
%201.svg)
Copyright © 2025 MedFrontiers. All Rights Reserved.
