The bladder is the organ in the human body that stores urine temporarily to be released later through the urethra. It is, therefore, a very important part of the body. Unfortunately, in some cases of bladder cancer, the bladder has to be removed.
The removal of the urinary bladder is done through a surgical procedure called "cystectomy." A cystectomy is normally done in patients with cases of an invasive cancer of the bladder, wherein cancer has already spread to the surrounding tissues or organs. In other procedures such as radical cystectomy, it is not only the bladder that is removed but also some of the surrounding organs.
In both men and women, the lymph nodes may also be removed. In men, their prostate gland and a part of their urethra may be removed as well. Women, on the other hand, may also lose their cervix, womb, fallopian tubes, part of their vagina, and even their ovaries.
There are various types of surgeries that can be done to remove the bladder. To some people with bladder cancer, they may only need a partial removal of their bladder. Others may need their whole bladder be removed, while some may need the removal of their bladder and other organs.
However, having a bladder removal does not mean that you will not continue to live just because you do not have a bladder anymore. It is still possible to continue living a healthy life even after your bladder is removed. To understand bladder removal better, it is important to know the various surgical procedures that are involved in the removal of the bladder.
Which surgeries are involved in the removal of the urinary bladder?
"Cystectomy" is a type of surgery that is done to remove a part of the bladder or all of it. There are two types of cystectomy: partial and radical cystectomy.
It is a surgical procedure done to remove a part of the bladder that has a tumor. This procedure is done if cancer has affected only the muscle layer of the bladder wall at a specific point and is not very large in size. The tumor is removed together with that part of the bladder and the hole is then closed.
The surrounding lymph nodes may also be removed and checked for cancer. Very few people get this type of surgery. Its advantage is that people who will undergo partial cystectomy will not require a reconstructive surgery and they will also retain their bladder. However, a patient should go for regular check-ups to ensure that cancer cells do not appear in other parts of their bladder.
This surgical procedure is done in cases where the tumor has affected an extensive part of the bladder and may have spread to the surrounding tissues. During a radical cystectomy, the whole bladder is removed as well as the surrounding lymph nodes.
Furthermore, men will have their prostate, part of their urethra, and seminal vesicles removed. In women, their womb, uterus, fallopian tubes, ovaries, cervix, and part of their vagina may also need to be removed.
How Is Cystectomy Done?
The two surgeries are usually done under general anesthesia. An incision is done at the abdomen in order to reach the bladder and remove it. The surgeon may also decide to carry out the surgery by making smaller incisions and then using special long and thin instruments to do the procedure. A video camera is usually fixed on one of the instruments to help the surgeon see inside. This procedure is called "laparoscopic surgery."
In a laparoscopic surgery, the surgeon may do it himself or by controlling robotic arms to carry out the procedure. Using robotic arms in a surgery is called a "robotic cystectomy." All cystectomy procedures should be done by a qualified surgeon in order to minimize the chances of cancer from returning back even after the surgery.
What Are the Risks of Cystectomy?
The issues that may arise after the operation are similar to those of other major surgeries. They include:
- infection at the site of the surgical incision
- damage to the organs surrounding the bladder
- pain (can be minimized by using painkillers)
- damage to the nerves
The Effects of Cystectomy on Urination
Partial cystectomy reduces the initial capacity of the bladder to hold urine, which means that you will experience more frequent urges of passing urine. There is also an increased chance for you to be at risk of developing urinary incontinence.
For people who have had a radical cystectomy, they will require other ways of dealing with urination. Passing of urine may involve reconstructive surgeries. The types of urinary reconstruction and diversion are:
- Incontinent urinary diversion
- Continent diversion
Incontinent Urinary Diversion
In this surgery, a small piece of the intestine is used to create an ileal conduit (a passage way) for urine to pass out from the kidneys to the outside of the body where it is collected in a pouch. The ileal conduit is connected to the ureter, which in turn is joined to the kidneys.
The opening of the conduit at the skin is known as a stoma, and that is where the pouch is placed. The pouch collects urine in small amounts until it is full and needs to be emptied.
Continent Urinary Diversion
In this method, a pouch is made by using a part of the intestine and it is placed inside the body. It is connected to the ureters and one of its ends is connected at a stoma made in the skin. The urine gets stored in the pouch and is drained out at intervals using a catheter. This method is preferable because the pouch is not visible.
It is the most recently developed method of urinary reconstruction. It also involves the creation of a bladder using the intestines. The bladder is then fixed within the body. It is connected to both the ureters and the urethra. This type of urinary reconstruction method is unique since you will still pass urine normally.
The Side Effects of Bladder Reconstruction Surgeries
Bladder reconstruction surgeries deal with the diversion of urine flow. This can also have side effects such as:
- increased risk of developing infections
- formation of pouch stones
- leaking of urine at times
- a blocked urine flow
Dealing with Bladder Removal
Removal of the bladder will affect your normal pattern of life. There will be changes in the way that you will pass urine. You may also experience problems such as incontinence at night or leaking of urine at any time of the day. Living without a bladder may not only affect your social life but may also affect your sexual life.
Make sure that you will master the techniques on how to properly manage yourself when it is time to pass urine. Learn how to appropriately use the pouches and carefully follow the steps to carry out the urine draining procedures. In addition, you can improve your sexual life through the following ways:
- Empty the pouch and fixing it correctly before sexual intercourse.
- Use a pouch cover.
- Choose sex positions that will keep your partner's weight from overlying the pouch.
The Bottom Line
It is possible to live a healthy life even without a bladder. All of the above medical options can help you attain a normal life. Just make sure that you are always careful with the pouch. In case any psychological problems set in, you can visit a therapist to help you get back on track.