Open/ Robotic Radical Cystectomy with Ileal Conduit/ Neobladder and pelvic lymphadenectomy

Procedure– Radical Cystectomy is a surgery to remove the urinary bladder. In men, removing the entire bladder (radical cystectomy) typically includes removal of the prostate and seminal vesicles. In women, radical cystectomy also involves removal of the uterus, ovaries and part of the vagina. After your doctor removes your bladder, he or she makes a new way for you to pass urine. This is called an Ileal conduit . Ileal conduit is a part of intestine that is made like a pouch in which both the ureters (ureter is the tube that connects kidney to the bladder) are joined. One end of the conduit opens into the abdominal wall. Urine from the kidneys get collected in the conduit and get excreted into a bag which is pasted on the abdominal wall. this bag is weekly changed by the patient himself. Neobladder can also be made by using a segment of small intestine which is connected to the urethra. In neobladder formation patient may need to do self catheterization for sometime till the new bladder is fully functional.

Many people can return to work or their usual activities 4 to 6 weeks after surgery. But you will probably need 6 to 8 weeks to fully recover from the surgery. Bladder cancer surgery may affect sexual function. Radical prostatectomy is a major surgery from which your body needs time to recover.  Most men can start to drive 5-6 weeks after surgery. You should avoid heavy lifting for several weeks after surgery. It usually takes about six weeks for most men to feel back to normal.

Radical Cystectomy is a major operation. It may not be suitable if you have other health problems, such as heart disease, that would increase the risks involved. Following surgery, many men experience erectile dysfunction (ED), but for many, the disruption is temporary. Nerves damaged during surgery may result in erectile dysfunction.

Expect to receive instructions before leaving the hospital about restrictions to your diet and activities. You may be encouraged to begin light, everyday activities as soon as you feel able, but you’ll need to avoid strenuous activity or heavy lifting for several weeks.

For most patients, these procedures don’t affect quality of life — once you’re completely recovered, you can expect to resume your normal routine and activities.

Risks and complications –

1. Bleeding requiring blood transfusion- Radical cystectomy is a major surgery so blood is always arranged and kept in blood bank for any intraoperative or postoperative blood transfusion need. Such transfusions are needed in 5% of patients.
2. Infection -post operative wound infection may happen in 10% of cases which may require prolonged antibiotics and dressing.
3. Impotence/ Erectile dysfunction- Problems in getting or keeping erections happen in almost 80-90 % of patients. Nerve sparing prostatectomy if feasible can help in preserving the erectile function in some patients. Post operative use of Sildenafil or vacuum erection device do help in some patients in having intercourse after radical prostatectomy.
4. Visceral complications- Injury to the surrounding organs of prostate like rectum, blood vessels may happen which require immediate measures to repair it. Such incidences are rare and happens in lesser than 5% of patients.
5. Anesthesia related complications like chest infection, vomiting, headache may occur for few days in some patients.
6. Lower limb swelling- It may sometime develop due to pelvic lymph node removal. However, it gradually subside in the due course of time.
7. Deep venous thrombosis (DVT) and thromboembolism- This means formation of blood clots in large veins of limb which may migrate to distant veins/ lungs and heart. This is a rare phenomenon and reported in <1% of patients .