Refers to the surgical removal of all or part of the urinary bladder.

The most common condition warranting removal of the urinary bladder is bladder cancer.

Two main types of cystectomies can be performed: partial 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.

A urinary diversion is necessary to allow elimination of urine after complete cystectomy.

Radical cystectomy is the recommended treatment for bladder cancer that has invaded the muscle of the bladder., and is recommended for individuals with a high risk of cancer progression or failure of the cancer to respond to less invasive treatments.

Factors determining the type of cystectomy to be performed: age, health, baseline bladder function, type of cancer, location and size of the cancer, and stage of the cancer.

A partial cystectomy is performed for some benign and malignant tumors localized to the bladder, for 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.

Radical cystectomy is associated with frequent complications of about 60% with readmissions of about 30%.

Radical cystectomy has a relatively low risk of death, yet patients experience a prolonged recovery period of months.

Partial cystectomy may also be performed for removal of tumors which have spread from neighboring organs to the bladder.

A radical cystectomy is usually performed for cancer that has invaded into the muscle of the bladder.

With a radical cystectomy the bladder is removed along with surrounding lymph nodes 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.

With radical cystectomy an incision is made from just above or next to the umbilicus to the pubic symphysis: the ureters are located and cut free from the bladder, the bladder is separated and removed: the urethra may also be removed depending on tumor involvement.

In men, the prostate may or may not be removed, but 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.

A minimally invasive radical cystectomy-robot-assisted laparoscopic radical cystectomy (RARC) may be an option.

Robotic-assisted or laparoscopic surgery is contraindicated for individuals with severe heart and lung disease, positioning and abdominal insufflation places extra strain on the chest wall impairing lung function and the ability to oxygenate the blood.

There are no specific contraindications to having a cystectomy.

Cystectomy should not be performed in individuals who are not healthy enough to undergo a major surgical procedure, who cannot tolerate general anesthesia, or who have severe or inadequately managed co-morbidities such as diabetes, heart, lung, kidney, or liver disease, who are malnourished, have problems with blood clotting, severe laboratory abnormalities or have an active illness or infection.

A partial cystectomy is contraindicated in carcinoma in situ (CIS), the presence of a severely diminished bladder capacity or cancer in very close proximity to the bladder trigone, where the urethra and ureters connect to the bladder.

Removal of the bladder necessitate urinary diversion in the form of an

incontinent urostomy, a continent catheterizable reservoir, or an ortho-topic neobladder.

Radical cystectomy risks and complications are due to the extent and complexity of the surgery.

Risks: anesthesia, bleeding, blood clots, heart attack, stroke, and pneumonia or other respiratory problems, risk of infection involving the urinary tract, abdomen, and gastrointestinal tract, surgical incision infection.

Radical cystectomy is inherently morbid with 59-69% of patients experiencing postoperative complications of any grade.

13%-22% of radical cystectomy patients experience a high-grade complication.

Ileus is the most common complication following cystectomy, due to manipulation of the intestines due to their proximity of the bladder, the actual operation on the intestines to create a urinary diversion, or even certain medications such as narcotics.

The small intestine can also become obstructed.

Modern cystectomy series report a median postoperative hospital stay of 6-9 days.

In the neoadjuvant chemo therapy era, five-year overall survival, recurrence free survival, and cancer specific survival following radical cystectomy range from 50-59%, 57-68%, and 65 to 76%, respectively.

After creation of a urinary diversion, intestinal contents can leak at the site where the intestine are reconnected.

Damage to nerves in the pelvis can occur during removal of the bladder or lymph nodes.

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