Cystectomy

Cystectomy is a medical term for surgical removal of all or part of the urinary bladder. It may also be rarely used to refer to the removal of a cyst. The most common condition warranting removal of the urinary bladder is bladder cancer. Cystectomy is a medical term for surgical removal of all or part of the urinary bladder. It may also be rarely used to refer to the removal of a cyst. The most common condition warranting removal of the urinary bladder is bladder cancer. Two main types of cystectomies can be performed. A partial cystectomy (also known as a segmental cystectomy) involves removal of only a portion of the bladder. A radical cystectomy involves removal of the entire bladder along with surrounding lymph nodes and other nearby organs that contain cancer. Evaluation of the tissue removed during cystectomy and lymph node dissection aids in determining pathological cancer staging. This type of cancer staging can be used to determine further work-up, treatment, and follow-up needed along with potential prognosis. After the bladder has been removed, a urinary diversion is necessary to allow elimination of urine. Radical cystectomy is the recommended treatment for bladder cancer that has invaded the muscle of the bladder. Cystectomy may also be recommended for individuals with a high risk of cancer progression or failure of the cancer to respond to less invasive treatments. When determining the type of cystectomy to be performed many factors are taken into consideration. Some of these factors include: age, overall health, baseline bladder function, type of cancer, location and size of the cancer, and stage of the cancer. A partial cystectomy involves removal of only a portion of the bladder and is performed for some benign and malignant tumors localized to the bladder. Individuals that may be candidates for partial cystectomy include those with single tumors located near the dome, or top, of the bladder, tumors that do not invade the muscle of the bladder, tumors located within bladder diverticulum, or cancer that is not carcinoma in situ (CIS). A partial cystectomy may also be performed for removal of tumors which have originated and spread from neighboring organs such as the colon. A radical cystectomy is most commonly performed for cancer that has invaded into the muscle of the bladder. In a radical cystectomy the bladder is removed along with surrounding lymph nodes (lymph node dissection) and other organs that contain cancer. In men, this could include the prostate and seminal vesicles. In women, this could include a portion of the vagina, uterus, Fallopian tubes, and ovaries. In an open radical cystectomy a large incision is made in the middle of the abdomen from just above or next to the umbilicus to the pubic symphysis. The following information provides general steps to the procedure and may occur in varying order depending on the surgeon. The ureters are located and cut free from the bladder. The bladder is separated from surrounding structures and removed. The urethra, which drains urine from the bladder, may also be removed depending on tumor involvement. In men, the prostate may or may not be removed during this procedure. Pelvic lymph node dissection (PLND) is performed. A urinary diversion is then created and the free ends of the ureters are reconnected to the diversion.