Urology Casablanca

Cystectomy

The operation proposed to you is intended to remove your bladder affected by a tumour. The bladder The bladder is the reservoir in which urine from the kidneys is stored before being evacuated during urination. Urine secreted by the kidneys is drained through the ureters to the bladder. During urination, urine is evacuated outside through the urethral canal. This channel is short in women (about 4 cm). In men, it is much longer (about 17 cm) and surrounded by the prostate in its first part under the bladder. Legend: pr: prostate; r: rectum; u: ureter; ur: urethra; ut: uterus; va: vagina; ve: bladder

 

 

 

 

 

 

 

 

 

​

Why this action? Samples taken from your bladder revealed a tumor. The characteristics of this tumor justify surgical treatment consisting in the removal of the bladder. This is the current reference treatment for the type of tumor you have (tumor affecting the muscle of the bladder or more superficial but high grade and recurrent tumour). The intervention is necessary because, in the absence of treatment, this tumor will evolve and expose you to the risk of urological disorders and pain as well as local and distant progression of the disease. Are there other possibilities? Conservative treatment of the bladder using radiotherapy and/or chemotherapy may be offered in some cases. The indications are limited and the remote results imperfectly assessed.

​

Preparing for the intervention As with any surgery, a pre-operative anesthesia consultation is required a few days before the operation. The urine must be sterile for the operation: a urine analysis is therefore carried out before the operation to check the sterility of the urine or to treat a possible infection, which could lead to postponing the date of your operation. The intestine which is likely to be used during the intervention must be prepared by a residue-free diet starting a few days before the operation and by ingesting a liquid the day before the operation to empty the intestine. The operation takes place under general anesthesia. Surgical technique The approach is an abdominal incision. The operation involves removing the entire bladder. In the vast majority of cases, the surgical procedure also removes the prostate in men and the uterus in women. To allow the elimination of urine, there are several possibilities: - restoration of natural urinary continuity by interposing an intestinal reservoir between the ureters and the urethral sphincter. - diversion of the ureters into a colonic reservoir with elimination of urine through the anus. - diversion of urine to the skin The choice between these different techniques depends on many criteria (seat of the tumour, age, sex, general condition and anatomical conformation). It may be indicated in some cases in men to remove the urethral canal in its entirety in certain types of tumor. It is therefore not possible in these cases to consider a replacement of the bladder and the derivation of urine to the outside is necessary. At the end of the operation, depending on the urinary diversion, one or two pockets (stomies) will be in place. In the case of a bladder replacement, two probes in the ureters and one probe in the new bladder will have been positioned. Also, at the end of the operation, one or more drains will have been put in place; they make it possible to monitor the flow through the operating site.

Remote Risks - digestive complications - urinary complications All these late complications can justify a surgical intervention or a specific gesture. Side effects on continence and erections If you were able to benefit from a complete restoration of urinary continuity, it is rare that you are immediately continent. During the day, the almost obligatory leaks at the time of removal of the probe will generally decrease quite rapidly. At night, complete continence is often difficult to achieve and may sometimes require regular getting up. For these continence problems, you can be helped by specific rehabilitation. The ablation of the prostate and the seminal vesicles being most often carried out during the ablation of the bladder, the result is a disappearance of ejaculation. Similarly, during the intervention, the risk of injuring the erection nerves is significant. It is therefore common to no longer have erections after removal of the bladder. Various treatments for this erectile dysfunction are possible and will be offered to you. Your urologist is at your disposal for any information.