Bladder cancer is the most common reason for bladder surgery. Different surgical procedures are used based on the stage of the cancer. Localised tumours in the mucous membrane can be removed with a transurethral bladder resection. If the entire bladder needs to be removed, different procedures are possible for a replacement bladder or a urostomy based on the individual patient's situation.
If the urethra is retained when the bladder is removed, a new bladder can be constructed from the small intestine. If the urethra is removed, the urine must be redirected out of the body through the skin via an artificial bladder outlet.
What preparations are carried out before the procedure?
Different examinations are carried out to identify diseases of the bladder. They include ultrasound, blood and urine tests, cystoscopy, CT scan and MRI.
All the usual pre-operative assessments are required, such as a blood test, blood pressure measurement and an ECG. All blood-thinning medication must be discontinued prior to surgery. Bladder surgery is carried out under general anaesthetic or with spinal anaesthesia. The choice of anaesthesia depends on each patient’s individual situation. Patients must have an empty stomach for the procedure.
How is the operation carried out?
Bladder removal, cystectomy
Bladder cancer which is still limited to the mucous membrane of the bladder can be operated on without having to remove the entire bladder. If the tumours are smaller, this can even be done over the urethra. During this transurethral bladder resection, the tumour is removed during a cystoscopy.
However, if the bladder cancer has affected a large part of the bladder or has grown into the muscle tissue, the entire bladder has to be removed. The bladder can be removed in an open operation or with the minimally invasive [laparoscopic method]. The method which is chosen depends on the patient's individual situation. If an open operation is carried out, entry to the body is gained via a larger incision in the lower stomach. Several small steps are required for a laparoscopy.
Firstly, the blood vessels of the bladder are ligated and closed. Then the ureter and the urethra are separated. The bladder is carefully exposed and removed. The localised lymph nodes near the bladder are also removed. If the tumour has grown into the surrounding tissue, the neighbouring organs may also have to be removed, depending on the situation. For example, this can affect the uterus in women, and the prostate in men.
A new bladder is sewn together for the replacement bladder from a part of the small intestine (neobladder), and connected with the ureter and the urethra. In this way, the urine can collect in the neobladder and be emptied via the urethra as per usual.
Artificial bladder outlet, cystostomy
In cases where no replacement bladder is possible or even if the urethra had to be removed, an artificial bladder outlet (cystostomy) is attached. A part of the small intestine is also used here. However, unlike a fully functional neobladder, this replacement bladder is not attached to the urethra but rather diverted out directly through the skin. In general, there are two procedures available. The navel pouch method allows a fully functional bladder to be created from the small intestine which is directed through the navel with a ventilation mechanism. Patients learn to catheterise themselves via their navel.
In the case of the ileal conduit method, a new piece of the small intestine is attached to the ureter. This is not a replacement bladder with a reservoir for the urine. The urine is directed continuously directed through the skin to the outside in a sac.
What is the success rate of this procedure?
The prognosis for cancer of the bladder depends on the stage of the disease. If the tumours have not metastasised, the prospects of recovery with bladder surgery are high.
What are the possible complications and risks of this procedure?
As with all surgery, the operation may occasionally lead to post-operative bleeding, nerve damage or infections. In rare cases, the transurethral operation can damage the urethra. A cystectomy can sometimes result in sexual dysfunction. Particularly if the prostate was also removed.
What happens after the operation?
After the operation, you will be monitored in the recovery room for a few hours. The drainage tubes are removed in two to three days. Patients who undergo this operation must usually stay in hospital for three to five days.
After the attachment of a neobladder or an artificial bladder outlet, the patient must relearn how to urinate. A stay in a specialist reha hospital is generally also recommended. There you will learn pelvic floor exercises to train the function of the neo bladder. Wearers of bladder stoma are taught how to handle and care for the artificial bladder outlet.
People who have undergone this operation should avoid major physical exertion in the first four to six weeks after the operation. Please make sure that you drink enough fluid. There will be a follow-up examination with a urine test one or two weeks later.
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