Cystoprostatectomy

• Cystoprostatectomy is a major surgery involving the removal of the bladder and, in men, the prostate, usually for muscle-invasive bladder cancer.
• The procedure often includes lymph node dissection and requires urinary diversion, such as an ileal conduit or neobladder.
• Preparation involves comprehensive medical evaluation, while the surgery can be open or robot-assisted laparoscopic.
• Recovery is extensive, typically requiring several weeks to months, with careful management of pain and urinary diversion.
• Potential risks include infection, bleeding, bowel complications, and issues related to the urinary diversion.

What is Cystoprostatectomy?

Cystoprostatectomy is a radical surgical procedure involving the complete removal of the urinary bladder (cystectomy) and, in men, the prostate gland (prostatectomy). It is primarily indicated for muscle-invasive bladder cancer, or high-grade non-muscle-invasive cases unresponsive to other treatments. The surgery aims to eradicate cancer and prevent metastasis. It often includes removing surrounding lymph nodes (lymphadenectomy). Following bladder removal, a urinary diversion is created, such as an ileal conduit (using small intestine for a stoma) or a neobladder (an internal pouch for more natural voiding).

Cystoprostatectomy Procedure Explained

The **Cystoprostatectomy Procedure Explained** encompasses pre-operative preparation, surgical removal, and reconstruction. Prior to surgery, patients undergo thorough medical evaluations, including blood tests and imaging, to confirm fitness for the extensive operation. Medication adjustments and bowel preparation may be required. The surgery can be open (large abdominal incision) or robot-assisted laparoscopic. During the procedure, the surgeon removes the bladder, prostate, and regional lymph nodes. Subsequently, urinary diversion is created. This involves either an ileal conduit (a segment of small intestine forming a stoma on the abdomen) or a neobladder (an internal pouch from intestinal tissue connected to the urethra for more natural voiding).

Recovery and Risks of Cystoprostatectomy Surgery

The **cystoprostatectomy recovery time** is substantial, typically spanning several weeks to months due to the surgery’s major nature. Post-operation, patients are closely monitored in the ICU before moving to a regular room. Pain management is critical, and patients will have various drains and catheters. Early mobilization is encouraged to prevent complications. Hospital stays generally range from 7 to 14 days. At home, recovery continues with focus on urinary diversion management, wound care, and gradual activity increase. Full recovery, including return to normal activities, may take three to six months, with regular follow-up appointments crucial for monitoring and cancer recurrence checks.

Inherent **risks of cystoprostatectomy surgery** include:

• Infection: Surgical site infections, urinary tract infections, or pneumonia.
• Bleeding: Significant blood loss during or after surgery, potentially requiring transfusions.
• Bowel Complications: Ileus (temporary paralysis of the bowel), bowel obstruction, or anastomotic leaks if bowel segments were reconnected.
• Urinary Diversion Issues: Stoma complications (stenosis, retraction), leakage from the neobladder or conduit, or metabolic imbalances.
• Nerve Damage: Potential for nerve injury, leading to erectile dysfunction in men or changes in sensation.
• Blood Clots: Deep vein thrombosis (DVT) or pulmonary embolism (PE).
• Anesthesia Risks: Reactions to anesthesia, including respiratory or cardiac issues.

According to the American Cancer Society, bladder cancer is the sixth most common cancer in the U.S., with an estimated 83,730 new cases in 2024. While specific cystoprostatectomy statistics are less common, it remains a vital option for advanced cases. Patients should thoroughly discuss all risks and benefits with their surgical team.