Radical cystectomy / cystoprostatectomy with anterior exanteration with ileal conduit / neobladder for muscle invasive bladder cancers
Urinary bladder removal is known as cystectomy. Radical cystectomy is when the bladder and surrounding covering tissues and lymph nodes are removed, usually in cancers.
There are times when the bladder needs removal. This includes the following conditions:
- Muscle-invasive bladder cancer
- Recurrent superficial / non-muscle invasive bladder cancer
- High grade superficial / non-muscle invasive bladder cancer which is difficult to be cleared
- Treatment of other pelvic tumors like advanced colon, prostate or endometrial cancer which has infiltrated and involved the bladder
- Non-cancerous (benign) conditions like interstitial cystitis or congenital abnormalities, which has failed conservative, non-interventional treatment.
Muscle-invasive bladder cancer is the commonest reason for bladder removal.
- In men, it requires removing the entire bladder (radical cystectomy) including removal of the prostate and seminal vesicles.
- In women, radical cystectomy also involves removal of the uterus, ovaries and part of the vagina.
After the bladder is removed, you will require a urinary diversion — a new way to store urine and have it leave your body. There are multiple ways that urine can be stored and eliminated after bladder removal. This may be achieved by an ileal conduit or a neo-bladder, by using the small portion of your intestine to create this conduit or neo-bladder. Your urologist will discuss this with you in more detail.
Often, cystectomy is performed to treat invasive or recurrent noninvasive bladder cancer. Cystectomy may also be performed to treat other pelvic tumors — such as advanced colon, prostate or endometrial cancer — and some noncancerous (benign) conditions — such as interstitial cystitis or congenital abnormalities.
Bladder removal in deep (muscle invasive) bladder cancer
The removal of the bladder in deep (muscle invasive) bladder cancer is the best way to achieve cure in muscle invasive bladder cancer.
When the bladder is removed with its surrounding lymph nodes, the bladder needs to be substituted with a urinary conduit or a reservoir. This can be achieved by utilizing the small or the large intestine, re-model it into a conduit or a reservoir, and to establish continuity of the urinary tract system.
Urinary diversion after bladder removal: (Illustrations from the 2016 ACS NSQIP Annual Conference)
The intestinal conduit formation and urostomy bag
The neobladder and an intestinal pouch after bladder removal