After removal of the bladder for cancer. Bladder cancer is a group of oncological tumors of different nature

When is removal necessary? Bladder prognosis and life expectancy for cancer. The operation helps not only save the patient’s life and reduce the likelihood of relapses, but also gives a fairly optimistic prognosis for survival and recovery full life. Of course, a lot depends on the stage of cancer pathology, the condition of the patient’s body, as well as the presence and number of regional and distant metastases.

Radical cystectomy is performed for an invasive form of bladder cancer and involves removing nearby lymph nodes, internal genital organs and glands along with the bladder. In men, the prostate and seminal vesicles are removed, and in women, the uterus with appendages and part of the vagina are removed.

Bladder cancer occurs in older people (after 60 years). In men, this oncopathology develops several times more often than in women.

• men more often and more actively come into contact with various aggressive chemicals(amines, fuels and lubricants, petroleum products);
• diseases of the prostate gland in men, as a result of which, by increasing in size, the organ prevents the full outflow of urine;
• Smoking promotes the formation and growth of atypical cells, and more men smoke than women.

Invasive bladder cancer is a severe oncopathology and differs from non-invasive bladder cancer in that the tumor grows outward through the walls of the bladder and affects neighboring tissues and organs. Non-invasive neoplasms do not spread beyond the organ, but can become invasive over time.

1. The neoplasm actively grows from the surface of the mucous membrane of the bladder outward, affects neighboring organs, but does not have metastases.
2. There are single regional metastases that can be surgical removal.
3. On late stages cancer as a temporary relief when it is necessary to eliminate severe pain and bleeding.
4. In the early stages of cancer, when there is a high risk of recurrence.
5. There is a danger of a non-invasive tumor degenerating into an invasive one.
6. In the case of flat cancer that is not amenable to chemotherapy and immunotherapy with the BCG vaccine.

In some cases, it is possible to maintain potency in men after surgery to remove the bladder. To do this, a nerve-sparing operation is performed to preserve the nerve bundles responsible for erection. However, in this case there is a risk of incomplete removal of malignant tumors.

1. The patient's advanced age – unsatisfactory condition of the heart muscle, multiple chronic diseases may cause complications or death during surgery due to anesthesia.
2. Poor blood clotting can cause uncontrolled bleeding.
3. Acute inflammatory processes in the urinary tract can cause sepsis.
4. General serious condition patient.

Surgery to remove the bladder is a difficult intervention on the body and requires certain preparation on the part of the patient.

Before any oncological operation, an adequate risk assessment and thorough preoperative preparation, since this surgical intervention is highly traumatic and extensive.

Before removing the bladder, chemotherapy is performed to reduce the volume cancerous tumor. Patients who received neoadjuvant chemotherapy had a more positive prognosis for survival, even at stages T3 and T4 cancer.

• a comprehensive examination of the patient for chronic diseases and contraindications is carried out;
• a consultation is held with an anesthesiologist, all details of anesthesia, risks and features of the process are discussed;
• in the two-week period before surgery, probiotics are prescribed to prevent the risk of infection;
• two or three days before the cystectomy, a course of intestinal cleansing is carried out using a diet - food should be only liquid; a day before, laxatives are taken and an enema is performed;
• contamination is carried out - intestinal sterilization with antibiotics;
• In agreement with the doctor, you should stop taking certain medications two weeks in advance.

A month before surgery, the doctor will recommend stopping smoking and drinking alcohol to reduce the risk of complications after anesthesia and ease general condition. The evening before the operation, the patient may be prescribed sedative medications to stabilize psycho-emotional balance.

Surgery is long and takes from four to eight hours. Radical removal tumors in the bladder together with the organ are performed under general anesthesia. The patient's condition during the operation is monitored using special equipment, artificial ventilation lungs.

Women are operated on in a supine position with their legs brought up to their stomach (the legs are placed on special stands); in men, a horizontal position with straight legs is used without additional devices.

When all monitoring systems are established and the patient falls asleep, a standard incision is made.

1. Selection of rational access to the affected organs and optimal surgical technique in order to avoid unnecessary traumatic effects on the tumor.
2. The principle of radicalism. Organs are removed en bloc with tissue and lymph nodes. It is unacceptable to remove affected tissue in parts.
3. The principle of ablastics. Carefully isolate manipulation areas from other tissues to avoid dispersion cancer cells and leaving them in the wound.
4. The principle of anatomical zonation. The bladder is removed within healthy tissues as a single block, along with all tissues and organs affected by the cancerous tumor, as well as regional lymph nodes.
5. The principle of case. The tumor is removed without allowing its surface to be exposed, i.e. it must be in a shell of healthy tissue (covered with pleural films, muscles, fat, etc.).
6. Antiblastic principle. Treatment of the operation area with special anti-cancer agents.

The extracted organs are sent for histological examination.

After radical cystectomy, new pathways for urine drainage begin to form. Modern medicine has a number of methods by which the urinary process is restored.

Any operation can have certain consequences and complications. Cystectomy is a complex and highly traumatic operation that deeply affects the body.

• heavy blood loss during surgery;
• risk of wound infection;
• loss of erectile function in men due to the removal of the nerve endings responsible for erection along with the organs;
• narrowing of the vagina in women, which can prevent full sex life;
• a long period restoration of intestinal functions, which may require drainage of intestinal contents using a nasogastric tube;
• complications due to the use of anesthesia (problems with respiratory system, cardiovascular);
• the occurrence of blood clots in the vessels of the legs;
• liver problems;
• It is not always possible to defeat cancer with the help of surgery: metastases can manifest themselves in other organs after cystectomy.

In addition, unpredictable situations may arise due to the patient having any disorders or specific reactions.

The prognosis after radical cystectomy depends on many factors, but the survival rate of patients after removal of a tumor in the bladder is higher than with other oncological pathologies, even at advanced stages.

1. The rate of tumor growth, the extent of the affected areas and the depth of invasion into neighboring tissues and organs.
2. Metastasis to distant lymph nodes and organs. In the presence of such metastases, life expectancy is significantly reduced, since the body is destroyed by secondary neoplasms.
3. Oncopathology stage. On late stages As a rule, there are already numerous metastases, the tumor grows deep into neighboring organs and tissues.
4. Relapses of the disease occur in almost 25% of cases.

The quality of life after radical surgery will change in a certain way, however. gradually people adapt to the new condition associated with the absence of a bladder.

If the patient has formed a new bladder, then this will have virtually no effect on his lifestyle. Observe strict diet is not required, however, still, in order to avoid new health problems, it is necessary to change the way you eat and give up addiction– smoking.

Removal of the bladder (cystectomy)- a dangerous and difficult operation. It requires great professionalism of the surgeon, thorough preoperative examination of the patient and long-term rehabilitation period. Since the intervention this kind It is highly traumatic and is carried out strictly according to indications when there is no other way out. This is the most radical method of therapy. According to statistics, cystectomy is not required very often, which once again indicates that surgery to remove the bladder is a last resort.

IN medical practice There are two types of such intervention:

1. Removal of the bladder, during which resection of the organ is performed.
2. Total or radical cystectomy, when in a man, in addition to the organ itself, regional lymph nodes, seminal vesicles and, in some cases, part of the intestine and prostate are removed.

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Because the we're talking about about severe intervention, the list of indications is exhaustive and includes:

• Neoplastic processes of the bladder of a malignant nature at stages 3-4 (see). Removal of an organ is indicated only in cases where there are no metastases to surrounding organs, but the tumor has begun to grow into nearby anatomical structures. This is an opportunity to save the patient's life.
• Bladder shrinkage (microcysts). In this case, massive fibrous (scar) changes are observed on the part of the hollow organ. As a result of the pathology, the bladder is unable to stretch due to decreased elasticity. This is fraught with its rupture and the development of peritonitis. The disease is formed as a result of interstitial cystitis or tuberculosis.
• Developed papillomatosis of the bladder. Especially its diffuse form. The disease is characterized by the development of many benign formations(papillomas) scattered over the entire surface of the bladder. Typical for internal papillomatosis high risk malignant transformation of neoplasms.
• Malignant neoplasms of the bladder with single metastases to regional lymph nodes. In such a situation, the organ is removed along with the affected lymphatic structures.

In other cases, doctors prefer to perform less radical operations.

Contraindications

The list of contraindications, on the contrary, is approximate. Since we are talking about a difficult and lengthy operation, not everyone is able to endure such an ordeal. The operation cannot be performed:

• Elderly persons and old age due to the need for long-term anesthesia.
• People in serious condition.
• Patients with infectious and inflammatory diseases of the urinary tract in acute phase. There is a high risk of developing sepsis.
• Patients with low blood clotting.

The first two readings are absolute. Subsequent ones are relative and require correction of the condition.

Preoperative preparation

It is necessary to carefully examine the patient in order to reduce the risk fatal outcome And postoperative complications. The activities are typical for preparing for any surgical intervention, but there are some specifics.

Research and analysis

Direct preparation

• two weeks before you need to stop taking certain medicines: Aspirin and others;
• a week before surgery, the patient is transferred to a diet with low content fiber;
• for two days it is forbidden to eat and it is recommended to drink more;
• V mandatory hygienic treatment of the groin area is carried out;
• a day before, a cleansing enema and diuretics are prescribed in order to “drive out” excess liquid from the body;
• Smoking and drinking alcohol are prohibited 12 hours before;
• You should not drink liquids the evening before surgery.

The preparation doesn't end there. Almost two weeks later, the doctor prescribes the man a course of antibiotics to prevent secondary infection and prebiotics to normalize the intestinal microflora. In addition, such measures are necessary to prepare gastrointestinal tract: It is possible to use part of it for urine drainage.

Intervention techniques

The most common cystectomy technique is as follows:

• The patient is placed on the operating table. Treat the site of the intended incision antiseptic solutions, indicate the excision line. for urine drainage. In men, the urethra is long and narrow, there are anatomical bends that prevent the normal entry of the catheter. Therefore, the specialist must be careful not to damage the walls of the urethra.
• Next, an arcuate tissue incision is made two to three fingers above the pubis to expose the organ.
• The bladder is excised, the doctor examines the hollow organ.
• The walls of the organ are fixed, and the prostate gland is additionally fixed (during radical surgery).
• The doctor excises the ureters, ties the vas deferens, mobilizes the organs of the urinary system, cutting the ligaments.
• A secondary catheterization is performed to drain urine.
• The bladder itself is removed.
• Through the hole in abdominal cavity the surgeon inserts a special reservoir to temporarily collect urine.
• The doctor stitches up the wound.

The entire operation lasts about 6-8 hours. All this time the patient is under anesthesia.

Methods of urine drainage are very variable:

1. Creating a wet stoma, where the urinary canal is formed from a part ileum(required constant wearing urinal).
2. Formation of a stoma from other parts of the gastrointestinal tract.
3. Finally, most modern way postoperative restoration of normal urinary function consists of prosthetics - replacing the bladder with an artificial one.

Complications after surgery

Classic consequences include bleeding and secondary infection of the wound surface. However, the following conditions pose a great danger:

These are, however, solvable problems.

Recovery after intervention

The rehabilitation course lasts from six months to a year. Careful adherence to a low fiber diet is required. The diet should be sufficiently fortified (vegetables and fruits will help, but not too acidic). In this case, the amount of liquid consumed should be reduced to a liter per day. Shown decrease physical activity, including sexual. The patient learns to empty the urinary tract again; with prosthetics, this period can last up to 12 months.

Any disturbances in health should be immediately reported to the treating specialist.

Is there life after cystectomy?

Man is a creature with enormous adaptive capabilities. If all the specialist’s recommendations are followed, the patient can live a long and high-quality life. Sexual activity is also rarely impaired to the extent that sexual function is completely lost. It is necessary to overcome physical and psychological discomfort from the use of urinals or temporary incontinence during prosthetics. Provided that we are not talking about advanced oncology, the life expectancy of patients is tens of years. There is life after cystectomy. And its quality depends on psychological mood the person himself.

Removing the bladder is a difficult intervention designed to save the patient’s life. It is carried out only according to indications, but often there are simply no alternatives to cystectomy. In this case, the patient can only learn to live in new conditions.

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Removal of the bladder for cancer (radical cystectomy) is the most effective method therapy of pathology, usually performed in conjunction with removal of the prostate (in men), the uterus with ovaries and fallopian tubes (in women), nearby nodes, as well as excision of the proximal urethra.

Indications for use

The decision to remove an organ is made based on the results of a study of cancer cells and the degree of involvement in pathological process its muscle layer. That is why, for a tumor of significant size, wall resection can be performed, and for a small tumor, cystectomy can be performed.

Absolute indications for bladder removal include:

• muscle-invasive cancer;
• cancer in situ (pre-invasive cancer);
• total or subtotal tumor lesion;
• recurrence of superficial cancer after one time or another;
• unproductiveness conservative treatment held at initial stages;
• the appearance of blood impurities in the urine;
• organ shrinkage.

At the last stages of oncology, accompanied by metastases in other organs, cystectomy will not give positive results.

In such situations, radiation and chemotherapy are used to relieve symptoms and relieve pain.

Contraindications

Contraindications to surgical intervention are:

• old age - age-related changes heart muscles and chronic diseases can lead to the development of serious complications or death during surgery due to the use of anesthesia;
• poor blood clotting - surgery can lead to enormous blood loss;
• inflammatory processes that develop in the urinary tract, causing sharp character and can lead to the development of sepsis;
• serious condition of the patient.

Preparation

Cystectomy requires little preliminary preparation of the patient.

Firstly, a thorough examination of the patient is carried out for the presence of contraindications and existing chronic diseases.

Secondly, a consultation is held with an anesthesiologist, during which the nuances of anesthesia and all the risks associated with it are discussed.

Thirdly, a gentle diet is prescribed, excluding milk and products made from it, as well as solid food(dishes should have a puree-like consistency).

Fourthly, siphon enemas are done in the evening preceding the operation, and in the morning two to three hours before it begins - these actions will allow for complete cleaning upper sections gastrointestinal tract.

Fifth, antibiotics are prescribed that suppress intestinal microflora and purifying it as much as possible - this is required in order to be able to create an analogue of the organ instead of the removed one.

Sixth, on the eve of the operation, all blood thinning drugs are canceled.

Occasionally, patients before cystectomy of the bladder are recommended to undergo a course of radiation or chemotherapy.

Chemotherapy in this case makes it possible to reduce the size of the tumor and, accordingly, carry out the most organ-preserving interventions.

Moreover, neoadjuvant chemotherapy followed by organ removal can improve survival in patients with invasive forms of pathology and, especially when the process has already gone far.

The situation is somewhat different with preoperative radiation therapy. Not only does it not improve patient outcomes, but it also significantly increases the risk of postoperative complications and complicates the use of the intestine as a new urinary reservoir.

Operation description

Cystectomy is a labor-intensive operation, lasts from four to eight hours and is performed under general anesthesia. The patient's condition during manipulations is monitored using medical equipment. The lungs are mechanically ventilated.

Women are relieved of the tumor in a supine position with lower limbs, pulled up to the abdominal area (they are placed on special stands), for men - on their backs with straightened legs.

After connecting the equipment and the patient falling asleep under anesthesia, a classic incision is made.

Then the optimal access to the affected organ and the most appropriate technique for performing the operation are selected, which allows to minimize trauma to the tumor. Removal of organs is carried out within healthy tissues in one block simultaneously with tissue and lymph nodes - carrying out the operation in stages is unacceptable. The remaining tissues are carefully isolated in order to eliminate the possibility of malignant cells spreading and finding them in the wound.

The tumor is removed in such a way that its surface is not exposed, but remains in a shell of tissues not affected by the process - muscles, pleural films, fat, etc. During the operation, the wound surface is treated with anticancer agents. The removed material is sent for histology.

After removal, restoration is carried out urinary tract by creating a urostomy or artificial bladder from a section of the ileum.

Consequences

Any surgery is fraught with certain consequences for the body.

Cystectomy for cancer is a complex and highly traumatic operation. possible complications which may include:

• significant blood loss during surgery;
• insemination pathogenic microflora wound surface;
• loss of erection in men;
• narrowing of the vagina in women, worsening the quality of sexual life;
• a long period of restoration of the functionality of the patient’s intestines, which in some cases requires drainage of intestinal contents through a nasogastric tube;
• problems with breathing and cardiovascular system patient due to the use of anesthesia during surgery;
• liver pathologies;
• thrombosis of the lower extremities;
• the appearance of metastases in other organs.

What is the survival rate

According to statistical data, cystectomy can increase the life of patients by up to 50%, and in combination with chemotherapy and radiation therapy - up to 80%.

Pre-invasive cancer prognosis:

Preinvasive cancer (Cancer In situ) is the very beginning of the malignant process, preceding the invasive tumor. Pathologically changed cells in such cases are in one place, do not affect other areas, do not metastasize and do not grow into tissue. However, despite this, the oncological process has already started and is negative impact on the body.

The prognosis for In situ cancer is favorable and approaches 100% when the tumor is removed at the “zero” stage - such patients will live for a long time.

Prognosis of squamous cell carcinoma of the bladder:

The squamous layer is the cells located inside the organ. Accordingly, the tumor arising from that layer is called squamous cell. Prognosis for the treatment of this pathology directly depends on:

• the prevalence of the malignant process at the time of seeking medical help;
• the age of the patient and the presence of chronic diseases;
• general condition of the body (lack of bad habits significantly increases the chances of recovery).

However, in the initial stages of the disease, the chances of coping with it are quite high.

Forecast small cell cancer Bladder:

Small cell cancer is a rare pathology, usually detected late, which, in turn, determines a poor prognosis (the life expectancy of such patients after seeking treatment) medical care, as a rule, is about 1.7 years).

Cystectomy is an operative intervention, the essence of which is the extraction of the affected bladder. In some clinical situations (strictly according to indications), a radical type of this operation is performed. In this case, a simultaneous removal of both the bladder and the prostate gland with replaced vesicles is performed. Urethral resection is also performed. Removing the bladder in men can have very different consequences. Much depends on the quality of the intervention performed, how traumatic it is, and also on how the process of urine diversion after the operation will be organized.

Etiological factors

The main reasons for removing the bladder in representatives of the stronger half of humanity are as follows:

1. Cancer of the bladder. In this case, doctors can still try to resort to conservative therapy methods. If there is a malignant tumor, then in order to prolong a person’s life they immediately resort to cystectomy;
2. Traumatization of the bladder (especially with a violation of the integrity of its walls);
3. Various problems of neuromuscular control over this organ;
4. Bladder failure after exposure to it radiation therapy and chemotherapy.

It is important to know not only the indications, but also the contraindications for such radical intervention. Cystectomy for men is not performed in the following cases:

• the presence of distantly localized metastases;
• malignant in nature;
• stress urinary incontinence;
• the presence of central nervous system pathologies in a person, in which muscle structures are primarily affected pelvic floor(together with the external sphincter);
• poor functioning of the internal sphincter;
• oncological lesion of the vesical triangle.

Stages of bladder removal

Almost all representatives of the stronger sex who are offered such an intervention are asked the same question - how is the bladder removed and what is it replaced with? This whole process is conventionally divided into several stages, which have their own specifics: the preparatory period, surgical intervention and postoperative period.

Preparatory stage

On the eve of surgical intervention, the treatment plan must include laxatives and antibiotics. This is done for the sole purpose of cleansing the intestines and preventing possible infection. The evening before the intervention, the patient is prohibited from eating any kind of food. You can drink, but only clear, not colored drinks. Some categories of patients need to stop taking certain medications a week before the intended intervention. pharmaceuticals, in particular anti-inflammatory and agents that have a thinning effect on the blood.

If, simultaneously with the extraction of the bladder, manipulations are carried out to divert urine into the intestines or skin covering and the formation of a new organ from a certain section of the intestine, then in this case Special attention in the preoperative period, attention will be paid to the preparation of the gastrointestinal tract. A week before surgery, the patient is prescribed:

• special diet with complete absence fiber;
• bowel cleansing is carried out daily using siphon enemas;
• anti-inflammatory drugs are prescribed to suppress the activity of microorganisms localized in the intestines;
• 3 days before the planned intervention, the patient is prescribed opium tincture. This is done to suppress intestinal motility.

Video: Bladder cancer

Bladder removal is a very serious intervention that is prescribed only in extreme cases. Most often, this operation is performed when malignant formations in this organ, when no other methods lead to the patient’s recovery.

The first operation to remove the bladder was performed in the 19th century, and the method that was used then is still used by surgeons today. Of course it is slightly improved, but there is no fundamental difference. Bladder resection is elective surgery; exceptions are emergency situations which are accompanied by bleeding.

The clear indication for surgery is cancer tumor, starting from stage 2, or if the formation is at early stage greatly affected the organ. Usually behaves like this papillary cancer, at which it is shown complete removal organ. This intervention is called radical cystectomy. If part of an organ is removed, then such an intervention is called segmental. Radical cystectomy is necessarily accompanied by reconstruction of the organ in any possible way.

Cystectomy is prescribed in the following cases:

• the urinary cavity is deformed;
• there is bleeding;
• oncology;
• the tumor affects nearby organs;
• neoplasms progress and do not respond to other treatment methods, such as chemotherapy;
• the tumor reappeared after transurethral resection;
• education is too big.

There are also contraindications for cystectomy, these include:

• the presence of severe diseases of other organs and systems;
• serious condition of the patient;
• poor blood clotting.

Types of bladder surgery

Depending on the severity of the disease and the location of the problem area, operations are divided into open (in which the abdominal wall is cut) and endoscopic (transvaginal or transurethral).

The surgical intervention may be as follows:

• cystolithotripsy and cystolitholapaxy - removal of stones;
• organ resection;
• transurethral resection;
• cystectomy.

Anesthesia can be local, general or spinal. The choice of pain relief method depends on the patient’s condition, what chronic diseases he has, and also takes into account the patient’s wishes.

What examinations are performed before surgery?

In order to correctly make a diagnosis and make a decision about surgery, the doctor must have an accurate idea of ​​where exactly the pathology is, what size the tumor is, and what its structure is. To do this you need:

1. Ultrasound. This is the simplest examination in which pathology can be identified and the first information about it can be obtained. Ultrasound can be cutaneous, or it can be transvaginal, transurethral or transrectal.
2. Endoscopic examination (cystoscopy). A special device is inserted into the patient through the urethra, which shows the doctor the entire inner surface Bladder. In addition, this method allows you to take material from the tumor for histology.
3. Urine analysis for the presence of atypical cells.
4. Urocystography with contrast agent.
5. A CT scan is prescribed in order to determine the exact location of the tumor, find out its size, consider the condition of the lymph nodes and neighboring bladder organs.
6. To assess the condition and traffic of departments urinary system, intravenous urography is prescribed.
7. In oncology, a CT scan of all organs of the peritoneum is also prescribed to monitor the presence of metastases.

However, not all of these diagnostic procedures are prescribed to each patient, since many of them are additional to clarify the diagnosis. As for the tests required for all patients, these are blood and urine, x-ray, HIV antibody test, viral hepatitis, syphilis, consultation with specialists if there are chronic diseases. If the patient is diagnosed inflammatory process, then urine culture and antibiotic treatment are necessary.

How to prepare for surgery

After the doctor prescribes a cystectomy, he will definitely tell you how to prepare for the operation. Within a week, the patient should switch to easily digestible liquid food that contains minimal amount fiber.

36 hours before the intervention, the patient should stop eating and drink only tea, juices or compotes. Milk and dairy products are prohibited. A day before, you need to cleanse your intestines and take diuretics. Before surgery, the patient is removed hairline from the groin and abdomen area, this is necessary in order to exclude the possibility of infection entering the wound.

How is the operation performed?

Resection of the bladder in women is combined with the removal of the urethra and paravesical tissue; the uterus and the fallopian tubes. If necessary, the iliac veins are excised. The lymph nodes and perform a hysterectomy. Bladder removal in men involves removing the prostate, seminal vesicles and lymph nodes in the pelvis.

If the patient is weakened, the operation is performed in 2 stages. First, ureterocutaneostomy and ureterosigmoanastomosis are performed, and then the organ is directly removed. With extraperitoneal intervention, extraperitonealization of the organ is performed; so that it doesn't happen heavy bleeding, iliac arteries bandaged.

Complete removal of an organ - complex operation: In addition to organ resection, surgeons will have to create ways for urine to drain out. One of them is ureterocutaneostomy - the ureters are brought out to the skin or in sigmoid colon. There is also a way to form a rectal bladder.

The stages of surgery are as follows:

• the patient's skin in the areas of the intended incisions is processed;
• V urethra a catheter is inserted, which is necessary to drain urine during surgery;
• the surgeon exposes the bladder and fixes it;
• the organ cavity is opened and examined;
• provided that the ureters do not move into the sigmoid colon, they are excised;
• catheterization is performed;
• the bladder is excised, the vessels are sutured, drainage is installed;
• a new bladder is formed;
• the wound is sutured layer by layer, with the exception of the place for drainage;
• a sterile bandage is applied.

Laparoscopic bladder removal

During laparoscopic surgery, the patient receives general anesthesia. Despite the fact that this intervention is less traumatic than abdominal surgery, the complexity of the operation remains high. The operation takes several hours. IN abdominal wall punctures are made into which special instruments and a video camera are inserted, allowing the surgeon to monitor the process.

First of all, the vessels that supply blood to the bladder are ligated. Then resection of the bladder, uterus with appendages or testes with prostate gland is performed. Next, a reservoir is formed to collect urine, which is sutured to the urethra.

Consequences and complications after surgery

Since surgical intervention associated with the removal of the bladder is very serious and difficult, in 60% of cases the following consequences occur:

1. After surgery, the colon will take several months to return to normal.
2. Erectile function in men disappears.
3. In women, the size of the vagina decreases (this will lead to sexual intercourse becoming impossible).
4. After bladder removal oncological processes may not disappear.
5. Infectious inflammation may occur in the wound or in the intestines.
6. The patient may lose a large number of blood.

Rarely, the following complications may occur:

1. Blood clots in the extremities.
2. Over time, liver function may decline.
3. The ureter at the junction with the intestine will narrow.
4. A relapse of cancer will begin to develop in the urethra.
5. The acid level in the blood may increase.

In very rare cases, you may experience:

1. Urine leakage.
2. Intestinal damage.
3. Damage to large vessels.
4. Intestinal injury that will require a bypass.
5. The need for another surgical intervention.

Rehabilitation period

After the operation, the patient will be allowed to get up and walk only on the second day. To avoid congestive pneumonia, it is recommended to do breathing exercises. Urine will be drained through a catheter for 3 weeks, fluid and nutrients in the first days the patient receives it through droppers, since the intestines do not work at this time.

As a rule, the patient’s hospitalization ends after 2 weeks, then he is discharged with urinary catheter. 10 days after discharge, the patient must return to the department to have the catheter removed. Before discharge, the patient is prescribed painkillers and anti-constipation medications; in some cases, antibiotics are indicated.

What should you pay attention to after discharge? If the patient has any following symptoms, then urgent consultation with a doctor is necessary:

• pain in chest, shortness of breath, swelling or painful sensations in the lower extremities;
• feverish condition;
• nausea, vomiting;
• The postoperative suture turned red, pain and a feeling of heat appeared at the incision site.

Diet after bladder removal

Nutrition after cystectomy should be discussed in detail with your doctor. How the patient eats during the postoperative period determines how smoothly the rehabilitation process will go. After removing one of the most important excretory organs Naturally, the functioning of the gastrointestinal tract is disrupted. In the first days after the intervention, the patient is not allowed to eat, then gradually it is possible to introduce dietary dishes, but give them in small portions. Food should be liquid coarse fiber it should not be present at all, or it is acceptable in small quantities.