Radical cystectomy and urinary diversion
Prof. Teoh Yuen Chun Jeremy
When bladder cancer invades deeply into the bladder muscle, endoscopic resection alone is not sufficient to obtain a cure. In this situation, patients will need radical cystectomy. Urine is produced by the kidneys and stored inside the bladder. Removing the bladder also means that we need some ways to divert the urine out from your body.
There are two main ways of achieving diversion of urine, namely creation of an ileal conduit and neobladder reconstruction. Ileal conduit is the simpler way of urinary diversion; a short segment of small bowel is used as a channel to drain the urine out. A stoma bag is needed to collect the urine and the patient needs to learn how to take care of the stoma.
For neobladder, a longer segment of small bowel is used to reconstruct a ‘bladder-like’ organ, aiming to resume the urine storage function similar to that of the original bladder. However, it is a complicated procedure that requires more stringent patient selection and post-operative care.
Radical cystectomy is a major surgery which aims to remove all bladder cancer cells from your body and hopefully obtain a cure. For patients undergoing radical cystectomy, pre-operative counseling is extremely important to help understand the whole surgery. The choice of urinary diversion has to be a thorough decision as this is something that a patient needs to live with after the surgery.
Illustration by @bowlful.of.rice