CONSULTANT
CONSULTANT
Jewel Urology Center, Mumbai
Nanavati Hospital, Mumbai
Saifee Hospital, Mumbai
DR. VIVEK VENKAT
Compassionate Evidence-Based Ethical Cancer Care
docvivek@gmail.com
WHAT IS RADICAL CYSTECTOMY?
- Radical cystectomy is a surgery where the entire bladder and its surrounding fat along with local lymph nodes are removed.
- In case of bladder tumors, this achieves excellent local cancer control and control of symptoms like pain and bleeding in urine.
- It can be done by an open incision or via a minimally-invasive robotic approach.
- Once the bladder is removed, urine is diverted via a short intestinal tube to the skin (ileal conduit) or a new bladder may be constructed from the intestine (neobladder).
- The choice of urinary diversion requires a detailed discussion between the doctor and patient and is based on tumor characteristics and location, patient factors like kidney function and dexterity, patient preferences and social factors (you can see our blod for details).
WHEN IS A RADICAL CYSTECTOMY NEEDED?
- Surgery is the gold standard or best treatment for bladder cancer that has invaded into the muscle layer of the urinary bladder (T2 and above).
- It may also be needed in patients with T1 disease who do not respond to BCG treatment or chemotherapy.
- Rare tumors like squamous cell carcinoma, adenocarcinoma, etc. are best treated with cystectomy.
- If the cancer returns after radiation treatment, a cystectomy is the only chance for cure.
- In patients in whom the cancer has spread to other organs a cystectomy may help control symptoms like pain or bleeding
ADVANTAGES OF ROBOTIC SURGERY
- Smaller incisions with less pain and scarring.
- Shorter hospital stay and quick return to normal activities.
- Reduced bleeding and blood transfusion rates.
- Lower risk for wound infection.
- Excellent magnified view allowing precise surgery and preservation of other organs.
- Much more ergonomic than laparoscopy.
Robotic surgery provides significant benefits for both patient and surgeon.
HOW TO PREPARE FOR RADICAL CYSTECTOMY?
- The need for radical cystectomy?
- Whether you are a candidate for a robotic procedure?
- Will you need chemotherapy before or after the surgery?
- What would be the diversion method of choice for urine in your case? Are you a candidate for a neobladder?
- What are the alternative treatments like radiation, partial cystectomy, etc. and are you a candidate for them?
- What further treatments might be needed?
Your initial bladder biopsy (TURBT) will provide the most accurate clinical staging of the cancer. After your imaging tests (CT scan or MRI or PET scan) you will discuss your options with your urologist:
- Basic blood and urine tests to assess fitness for surgery.
- Cardiac evaluation like ECG and 2D-Echo.
- To stop blood thinning medication for 5-7 days before the surgery.
- Anesthesia check-up and assessment.
- Healthy diet and exercise until the surgery.
- Admission the day prior or day of surgery.
- You will be on liquid diet only for the day prior to surgery.
- The site of stoma for an ileal conduit will be marked on your abdominal skin and you may see a stoma nurse before the procedure for further explanation.
To proceed with surgery the general instructions are:
WHAT TO EXPECT AFTER SURGERY?
- Speed of recovery depends on the extent of the surgery.
- After most robotic cases resumption of a liquid diet is within 48-72 hours after surgery and normal food in the next 2-3 days.
- You should also be able to get out of bed and walk a day after surgery.
- Pain after robotic surgery is mild and easily controlled with medications. For open surgery and more extensive cases stronger painkillers or epidural analgesia may be needed.
- Some patients may be kept in the ICU for observation for 1-2 days.
- You will have an abdominal drain for 4-5 days.
- In case of a neobladder you will have a urinary catheter to drain the bladder for 2-3 weeks.
- Most patients undergoing robotic surgery are discharged in 5-7 days. Open cases or more extensive surgeries may need a longer post-operative stay of 7-10 days
- You can resume light work in about 4-6 weeks after surgery.
- You can walk as much as you like but we recommend avoiding strenuous activity like lifting weights, golfing, going to the gym, etc. for 6 weeks after surgery.
- Patients undergoing a conduit will be taught care of the stoma and how to change the bag, etc. by the stoma nurse.
- Those undergoing a neobladder will need detailed instructions about self-catheterization and bladder washes which are needed after the procedure for few weeks to months.
WHAT ARE THE COMPLICATIONS OF RADICAL CYSTECTOMY?
- Bleeding Bladder cancers generally have a very robust blood supply and can even invade adjacent blood vessels. Bleeding is a significant risk in these surgeries and transfusion may be required. This risk is reduced with robotic surgery.
- Injury to adjacent organs In cases of large bulky tumors, adjacent organs like the rectum, small intestines, etc. may be stuck to the tumor. Sometimes this cannot be conclusively seen on the CT scan or MRI and the organs may need to be removed during the procedure.
- Delay in the recovery of intestinal function (ileus): This can happen after more extensive surgeries and may take up to a week to resolve sometimes.
- Erectile dysfunction Nerves supplying the penis for erection run very close to the bladder and prostate and may need to be removed during the procedure. Most men will experience erectile dysfunction which may take 2-3 years to recover.
- Metabolic complications As intestine is used to create a diversion certain elements in the blood stream like potassium, chloride, etc. need to be monitored regularly. Kidney function also needs to be monitored regularly as it can be affected with time.
- Complications of ileal conduit These are uncommon and include rashes around the stoma, hernias, sinking of the stoma or prolapse of the stoma.
- Complications of a neobladder These include difficulty passing urine needed the patient to catheterize themselves (5-10%), urinary leakage especially while sleeping (20-30%), blockage due to mucus and need for bladder washes, rupture of the neobladder (rare), stones in the neobladder, etc.
Every surgery carries a risk of complications. General complications may include anesthesia-related problems. infection, blood clots (DVT), pneumonia, cardiac events, etc. In addition, certain specific complications include:
WHAT ARE THE RESULTS OF RADICAL CYSTECTOMY?
WHAT MONITORING IS NEEDED?
- Radical cystectomy is the gold standard treatment for muscle invasive bladder cancer.
- It offers the best chance of cure and the exact prognosis depends on the stage and pathology of the tumor.
- Robotic surgery has much lower complications and quicker recovery than open surgery with no compromise in cancer control.
- Once the biopsy report is available you can discuss the follow-up schedule and tests with your uro-oncologist.
- Close monitoring of all patients is needed both to detect recurrences and to follow-up potential side-effects of the surgery.
- Depending on the pathology report and what treatment you have received previously, further treatment like chemotherapy may also be needed.
FAQs
Who are candidates for radical cystectomy?
Patients with urinary bladder cancer invading the muscle layer are best treated with radical cystectomy. Tumors not responding to BCG and those recurring after radiation may also need cystectomy.
What are the advantages of robotic surgery?
It allows a very precise surgery with fewer complications, better functional outcomes and no compromise in cancer control.
How painful is the surgery?
Pain is not severe and easily managed with tablet medications. Open surgery of more extensive procedures may require stronger medications or epidural analgesia.
When will I be discharged from hospital?
Most patients are discharged in 5-7 days after the surgery however this can take longer and depends on the extent of the procedure.
When can I resume normal work?
Work can be resumed usually 4-6 weeks after surgery.
Will I need additional treatment?
Most patients need chemotherapy before or after the surgery.
What urinary diversion can I choose?
The choice of diversion is a short intestinal tube to the skin (ileal conduit) or a new bladder constructed from the intestine (neobladder). This depends on many factors and requires a detailed discussion with your surgeon.
CONTACT US
Location 1:
Jewel Urology Center
No. 89, N. S. Road Number 1,
Navpada, JVPD Scheme,
Andheri West
Mumbai 400049, India
(m):+919136041545
Visiting Hours : Mon-Sat 4.30 - 6 pm
By appointments only
Email: appointments@drvivekvenkat.com
Phone:+919136041545
Whatsapp: +919136041545
Jewel Urology Center
No. 89, N. S. Road Number 1,
Navpada, JVPD Scheme,
Andheri West
Mumbai 400049, India
(m):+919136041545
Visiting Hours : Mon-Sat 4.30 - 6 pm
By appointments only
Email: appointments@drvivekvenkat.com
Phone:+919136041545
Whatsapp: +919136041545
Location 2:
Nanavati Max Hospital
S.V road, Vile Parle west
Mumbai 400056, India
Visiting Hours : Mon-Sat 2 - 4.30 pm
Email: appointments@drvivekvenkat.com
Phone:+919136041545
Whatsapp: +919136041545
Nanavati Max Hospital
S.V road, Vile Parle west
Mumbai 400056, India
Visiting Hours : Mon-Sat 2 - 4.30 pm
Email: appointments@drvivekvenkat.com
Phone:+919136041545
Whatsapp: +919136041545
Location 3:
Saifee Hospital
15/17, Maharshi Karve Rd,
Opposite Charni Road Station East,
Mumbai 400004, India
(m):+919136041545
Visiting Hours : Thursday 11am - 1 pm
By appointments only
Email: appointments@drvivekvenkat.com
Phone:+919136041545
Whatsapp: +919136041545
Saifee Hospital
15/17, Maharshi Karve Rd,
Opposite Charni Road Station East,
Mumbai 400004, India
(m):+919136041545
Visiting Hours : Thursday 11am - 1 pm
By appointments only
Email: appointments@drvivekvenkat.com
Phone:+919136041545
Whatsapp: +919136041545
