Medical & Surgical Urology
Open Access

Contraindications of Cystectomy, its Types and Risk Factors

Bruan Buic^{* *}Correspondence: Bruan Buic, Department of Surgery, University of Milan, Milan, Italy, Email:

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Description

The surgical removal of all or part of the urinary bladder is referred to in medicine as a cystectomy. Rarely, it may also be used to allude to cyst removal. Bladder cancer is the most frequent ailment that necessitates bladder removal. There are two basic types of cystectomies that can be done. A segmental cystectomy, also referred to as a partial cystectomy, simply removes a piece of the bladder.

A radical cystectomy entails the removal of the entire bladder along with any adjacent cancerous lymph nodes and tissues. Pathological cancer staging is aided by evaluation of the tissue removed during lymph node dissection and cystectomies. This kind of cancer staging can be used to evaluate whether additional testing, treatment, and monitoring are necessary, as well as a possible prognosis.

Contraindications

In general, having a cystectomy is not specifically contraindicated. Cystectomy, however, should not be done on those who are not healthy enough to have a significant surgical treatment. This includes patients who are unable to endure general anaesthesia as well as those who have severe or improperly controlled co-morbid conditions such diabetes, heart disease, lung disease, renal disease, or liver illness.

This also covers people who have serious laboratory abnormalities, blood coagulation issues, or malnutrition. People who are currently ill or infected should postpone surgery until they are well. For patients with serious heart and lung problems, robotic-assisted or laparoscopic surgery is not recommended. The placement and abdominal insufflation used during this type of operation put additional stress on the chest wall, reducing lung function and blood oxygenation.

In cases of Carcinoma In Situ (CIS), a kind of bladder cancer, a partial cystectomy is not recommended. Other reasons not to have a partial cystectomy include having cancer very close to the bladder trigone, which is where the urethra and ureters attach to the bladder, or having a drastically reduced bladder capacity.

Types

Many criteria are taken into account while choosing the type of cystectomy to be conducted. Age, general health, baseline bladder function, the type of cancer, its location and size, and its stage are a few of these variables.

Partial cystectomy: Some benign and malignant tumours that are localised to the bladder can be removed using a partial cystectomy, which only removes a section of the bladder. People who have a single tumour close to the bladder's dome or top, tumours that don't spread to the bladder's muscle, tumours inside the bladder diverticulum, or cancer that isn't Carcinoma In Situ (CIS) may be candidates for partial cystectomy. Tumours that started in and spread to nearby organs like the colon can also be removed with a partial cystectomy.

Radical cystectomy: The most frequent treatment for cancer that has spread to the bladder muscle is a radical cystectomy. A radical cystectomy involves the removal of the bladder, surrounding lymph nodes (lymph node dissection), and any additional cancerous organs. This might apply to the prostate and seminal vesicles in men. A portion of the vagina, uterus, Fallopian tubes, and ovaries may be affected in females.

Risk factors

Due to the magnitude and complexity of the procedure, radical cystectomy with the development of a urinary diversion may be associated with a number of risks and consequences. There is danger associated with anaesthesia, as there is with most major procedures, as well as risk of bleeding, blood clots, heart attack, stroke, pneumonia, or other respiratory issues. Additionally, infections of the digestive system, abdomen, and urinary tract are possible. There is a chance of infection at these locations when the surgical incisions are closed. Both open and minimally invasive cystectomy procedures have comparable complications.