Cystectomy Surgery (Bladder Removal) in Mumbai, India

Cystectomy is a surgical procedure that involves the removal of the bladder. It is commonly performed as a treatment for bladder cancer. Bladder cancer is one of the most common cancers in India and according to recent statistics, the 9th most prevalent type of cancer worldwide. Cystectomy is usually performed to treat bladder cancer that has not responded to other forms of treatment. It is also considered in earlier stages of bladder cancer, especially when it's invasive, to improve survival rates and reduce the risk of recurrence.

Cystectomy is a complex surgery that requires expertise and careful planning to ensure successful outcomes. Nanavati Max Super Speciality Hospital is one of the few healthcare facilities that offer cystectomy in Mumbai with highly trained surgeons and state-of-the-art equipment.

Types of Cystectomies

When it comes to treating bladder cancer, one of the most effective surgical options is cystectomy. There are different types of cystectomy, each varying in the extent of removal of the bladder, decided based on the factors such as the stage and grade of the cancer, the location and size of the tumors, and the patient's overall health and urinary function.

These include:

1. Partial Cystectomy: This procedure involves the removal of a portion of the bladder affected by cancer, while leaving the rest intact. It is typically performed when the tumour is smaller and confined to a specific area.
2. Radical Cystectomy: In cases where bladder cancer has spread or is at an advanced stage, a radical cystectomy may be recommended. This procedure involves removing the entire bladder, as well as nearby lymph nodes and in some cases, surrounding organs.
3. Total Cystectomy: Similar to radical cystectomy, total cystectomy involves the complete removal of the bladder. However, this procedure also includes removing nearby structures such as the prostate or uterus, depending on gender.

For radical and total cystectomy, for men nearby organs like the prostate and seminal vesicles and for women, uterus, and part of the vagina may also be removed, the procedure is often followed by urinary diversion or reconstruction to enable the body to expel urine.

Preparation for a Cystectomy

Before undergoing a cystectomy, there are several important steps and considerations that need to be taken. In this section, let's discuss the preoperative evaluation, dietary guidelines, medications and anaesthesia involved in the process.

Preoperative Evaluation

1. Prior to the cystectomy, the healthcare team will conduct a thorough evaluation to assess the individual's overall health and determine if he/she is a suitable candidate for the surgery.
2. This evaluation may include blood tests, imaging scans and other diagnostic procedures to ensure that one is physically prepared for the operation.
3. The doctor will also review the person's medical history and any existing conditions or medications that may impact the surgery.

Dietary Guidelines

1. It is essential to follow specific dietary guidelines before the cystectomy to optimise one's body's nutritional status and promote healing post-surgery.
2. The doctor or a registered dietitian may recommend certain modifications to the diet leading up to the procedure.
3. These modifications may include avoiding certain foods that can cause digestive issues or bloating, increasing one's intake of protein-rich foods to support tissue repair and staying hydrated by drinking plenty of water is essential.

Medications and Anaesthesia

1. The healthcare team will provide instructions regarding any medications one should continue or discontinue before his/her cystectomy.
2. Some medications might need to be stopped prior to surgery due to their potential effects on blood clotting or interactions with anaesthesia.
3. Anaesthesia will be administered during the procedure to ensure one is comfortable and pain-free. The type of anaesthesia used will depend on various factors, including his/her overall health and the extent of the surgery.

Procedure of a Cystectomy 

When it comes to treating bladder cancer, one of the most effective procedures is a cystectomy. This may sound like a drastic measure, but in cases where the cancer has spread or is aggressive, it can be a life-saving option. Decision to proceed with cystectomy is based on a thorough evaluation of the tumor's stage, the patient's overall health, and their capacity to tolerate major surgery.

Surgical Approaches

Here are some key points to understand about the surgical techniques and intraoperative considerations for cystectomy:

1. Open Cystectomy: This is the traditional approach where a large incision is made in the abdomen to access and remove the bladder. It allows for better visualisation and control during surgery, but longer recovery period and relatively greater postoperative pain compared to minimally invasive techniques.
2. Laparoscopic Cystectomy: In this minimally invasive approach, small incisions are made and a laparoscope (a thin tube with a camera) is inserted to guide the surgeon in removing the bladder. This technique offers faster recovery and less scarring compared to open surgery. As it requires advanced surgical skills, patients should perform adaquate research before selecting the surgeon.
3. Robot-assisted Cystectomy: Similar to laparoscopic cystectomy, this approach uses robotic arms controlled by the surgeon. The robotic system provides enhanced precision and dexterity, allowing for intricate movements during surgery. Nanavati Max Super Speciality Hospital is one of the few centres in Mumbai – equipped with the latest Da Vinci Xi robotic surgical systems for the Robot Assisted Cystectomy.

Intraoperative Considerations

1. Preservation of nearby organs: During cystectomy, surgeons take care to preserve nearby organs such as the prostate in males or the uterus in females, when possible. This helps maintain normal function and quality of life after surgery. However, the decision to save the life always supersedes organ preservation. Surgeons take the decision to preserve organs on a case-by-case basis, depending on oncologic safety.
2. Lymph node dissection: To ensure complete removal of cancer cells, lymph nodes in the surrounding area may be removed as well. This helps determine if cancer has spread beyond the bladder.
3. Urinary diversion: After bladder removal, it's important to establish an alternative way for urine to exit the body. Surgeons create a new pathway called a urinary diversion, which can either be an internal pouch or an external bag. The type of urinary diversion i.e. ileal conduit, continent cutaneous reservoir, or orthotopic neobladder is decided based on patient preference, kidney function, and the location of the cancer among others.

Risks of a Cystectomy

Undergoing a cystectomy is a significant procedure that comes with potential complications and long-term effects. It's important to be aware of these risks, if one is considering a cystectomy in Mumbai or any other location. Here are some key points to keep in mind:

Potential Complications

1. These risks may include infection, bleeding, blood clots, damage to nearby organs or tissues, and reactions to anaesthesia.
2. The risk of complications can vary depending on factors such as the patient's overall health and the extent of the surgery.

Long-term Effects and Risks

1. One potential long-term effect is urinary incontinence, which is the inability to control urination. This can significantly impact a person's quality of life.
2. Another potential long-term effect is erectile dysfunction in men. This can affect sexual function and intimacy.

As the intensity of these side-effects can be subjective, depending on success of the surgery, post-operative care and patients overall physiological condition, its ideal to discuss them with the surgical team before undergoing the surgery.

Complications of a Cystectomy

If one is considering a cystectomy in Mumbai or has already undergone the procedure, understanding these complications can help him/her make informed decisions and take appropriate steps to ensure his/her well-being. Like any other surgery, the risk and severity of complications can be subjective and is based on surgical expertise, post-operative care, infrastructure and most importantly, patient's physiological condition.

Here are some potential complications of cystectomy:

1. Infection: Post-operative infections are a common concern after any surgery, including cystectomy. Antibiotics are typically prescribed to prevent or treat infections, but it is essential to follow one's doctor's instructions and report any signs of infection, such as fever, pain, or unusual discharge.
2. Urinary Problems: After cystectomy, one will need to undergo urinary diversion surgery to create a new way for urine to leave the body. This can lead to complications such as urinary leakage (incontinence), urinary tract infections (UTIs), or difficulty emptying the bladder completely. Each type of urinary diversion also has its specific management requirements which should be discussed with the surgical team.
3. Bowel Problems: In some cases, cystectomy may require the creation of a neobladder using a segment of the intestine. This can result in bowel problems like diarrhoea, constipation or excess gas.
4. Sexual Dysfunction: Cystectomy can impact sexual function due to changes in anatomy or nerve damage during surgery. While some men, may experience erectile dysfunction, in women, changes in vaginal anatomy or function can be altered. It is important to discuss these concerns with the doctor who may recommend strategies or treatments that can help maintain intimacy and quality of life.
5. Complications from Anaesthesia: Like any major surgery, cystectomy carries risks associated with general anaesthesia. These risks include allergic reactions, respiratory problems, or adverse reactions to medications used during anaesthesia.

Recovery and Postoperative Care After a Cystectomy

After undergoing a cystectomy, it is crucial to provide oneself with ample time to recover and heal. The recovery timeline may vary depending on the individual and the complexity of the surgery.

Hospital Stay 

1. After a cystectomy procedure, the length of hospital stay can vary depending on the individual patient and the extent of the surgery.
2. On average, patients may need to stay in the hospital for about 7 to 10 days following a cystectomy.
3. During this time, doctors will closely monitor the patient's condition and provide necessary care to promote healing.

Managing Complications

1. While cystectomy is generally a safe procedure, there are potential complications that can arise. These complications may include infection, bleeding, blood clots, or issues with the formation of a urinary diversion.
2. Possible long-term issues such as urinary incontinence or sexual dysfunction are discussed with patients preoperatively as part of informed consent.
3. It is important for patients to follow their doctor's instructions carefully to minimise the risk of these complications.
4. Doctors will provide guidance on managing pain, promoting wound healing, preventing infections, and maintaining bladder function after surgery.

Life After a Cystectomy

Adjusting to Life Without a Bladder

1. Undergoing a cystectomy, the surgical removal of the bladder, is a life-changing experience. While it may take time to adjust physically and emotionally, many people are able to lead fulfilling lives after the procedure.
2. Without a bladder, it is necessary to create a new way for urine storage and elimination. There are different options available, such as an external bag (urostomy) or internal pouch (neobladder).
3. It may take some time to learn how to manage the new system effectively. The healthcare team will provide detailed instructions on how to care for his/her urostomy or neobladder.

The surgical team suggests a more suitable option based on patient's overall health, cancer stage, personal preference and other factors.

Quality of Life 

1. While adjusting to life without a bladder can be challenging, it's important to remember that there is still plenty of room for joy and fulfillment. With advancements in medical technology and ongoing research, the quality of life for individuals who have undergone cystectomy continues to improve.
2. Many people find that they are able to resume their regular activities and hobbies after recovery. It may be helpful to explore adaptive strategies or modifications that can allow one to continue doing the things he/she loves.
3. Eating a balanced diet, exercising regularly and getting enough rest can help promote healing and improve one's energy levels.

Support

1. Going through a cystectomy can feel overwhelming at times but remember that a person is not alone. There are various support groups, online forums, and resources available to help one navigate this new chapter in his/her life.
2. Connecting with others who have had a cystectomy can provide support, inspiration and valuable insights. Hearing about their experiences and learning from their tips and techniques can make one's own journey easier.

Why Should You Choose Nanavati Max Hospital, Mumbai for a Cystectomy?

If one is in need of a cystectomy surgery, it is crucial to find a hospital that provides excellent care and has a track record of successful outcomes. One such hospital that stands out is the Nanavati Max Hospital in Mumbai.

Here's why an individual should consider Nanavati Max Hospital for his/her cystectomy surgery in Mumbai:

1. Expertise in Cystectomy: The team of surgeons at Nanavati Max Hospital has extensive experience in performing cystectomy surgeries.
2. Advanced Facilities: Nanavati Max Hospital is equipped with cutting-edge technology and advanced surgical facilities. This enables the surgeons to perform complex cystectomy surgeries with precision and efficiency, leading to better outcomes for patients.
3. Multidisciplinary Approach: This means that a team of specialists from various fields collaborate to provide comprehensive care throughout one's treatment journey.
4. Personalised Care: The doctors and staff prioritise the individual's comfort and well-being, providing one with the support and attention one needs during this challenging time.
5. Positive Patient Ooutcomes: The hospital's commitment to quality healthcare has resulted in high success rates and improved quality of life for patients who undergo cystectomy surgery at their facility.

Frequently Asked Questions (FAQs)

1. How Do I Prepare For A Cystectomy?

You may be advised to undergo certain tests and stop taking certain medications before the procedure.

2. What Happens During The Cystectomy Procedure?

A cystectomy is a surgical procedure to remove all or part of the bladder.

The surgeon may also remove nearby lymph nodes and other affected tissues.

3. What Is The Recovery Process Like After A Cystectomy?

A person may experience pain and discomfort, which can be managed with medication. The healthcare team will guide the individual through post-operative care, including wound care and physical therapy.

4. What Is Life Like After A Cystectomy, Especially If The Bladder Is Removed Entirely?

After a cystectomy that involves removing the entire bladder, one will need an alternative way to pass urine. The doctor will discuss options such as an external bag or creating a new way for urine to exit one's body.

5. How Can I Find The Right Doctor For My Cystectomy?

It's important to find a doctor who specialises in urologic surgery and has experience with cystectomies.

6. Why Might Someone Need To Undergo A Cystectomy?

A cystectomy may be necessary to treat bladder cancer that has not responded to other treatments.

7. What Conditions Or Diseases May Necessitate A Cystectomy?

Bladder cancer is the most common reason for a cystectomy.

Other conditions include certain types of urinary tract infections, birth defects, and trauma to the bladder.

8. Are There Different Types Of Cystectomies?

Yes, there are different types of cystectomies depending on the extent of bladder removal. Partial cystectomy involves removing only a portion of the bladder, while radical cystectomy involves removing the entire bladder and surrounding tissues.

9. Is A Cystectomy A Major Surgery?

Yes, a cystectomy is considered a major surgery due to its complexity and potential impact on daily life.

10. Will I Need Any Special Preparations Before A Cystectomy?

The doctor will provide specific instructions on pre-operative preparations, which may include dietary restrictions and medication adjustments.

11. What Are Alternative Treatments To A Cystectomy?

Depending on one's specific condition, alternative treatments to a cystectomy may include radiation therapy or chemotherapy.

12. Can A Cystectomy Affect A Person'S Urinary Function?

Yes, after a cystectomy, especially if the bladder is removed entirely, one will experience changes in urinary function. The doctor will work with the individual to manage these changes and ensure optimal urinary function.

13. Is It Possible To Lead A Normal Life After A Cystectomy?

Yes, with proper post-operative care and support, many people can lead fulfilling lives after undergoing a cystectomy.

14. What Should I Expect During The Post-Operative Follow-Up Appointments After A Cystectomy?

The doctor will schedule regular visits to assess your progress and provide guidance on managing any ongoing issues.