Living Without a Bladder: What Happens After Cystectomy?
By Dr. Anup Ramani
A cystectomy, the surgical removal of the bladder, is often performed to treat bladder cancer, severe bladder dysfunction, or other significant bladder conditions. While the procedure can save lives, it dramatically changes the way a person manages bodily functions. Living without a bladder requires significant adjustments, both physically and emotionally. However, advances in medical procedures and rehabilitation strategies have made it possible for individuals to live fulfilling lives post-surgery.
In this article, we will discuss what happens after a cystectomy, the options available for patients who no longer have a bladder, and how they can adapt to life after surgery.
What is a cystectomy and why is it performed?
A cystectomy is a surgical procedure where the bladder is removed. It’s most commonly performed in the following situations:
- Bladder cancer: The most common reason for a cystectomy.
- Severe bladder dysfunction: This could include chronic conditions like interstitial cystitis or neurological conditions that impair bladder function.
- Bladder trauma: Such as a severe injury to the bladder that cannot be repaired.
There are two main types of cystectomy:
- Radical cystectomy: Removal of the entire bladder, often used in cases of cancer.
- Partial cystectomy: Removal of only part of the bladder, usually performed in non-cancerous cases.
After a cystectomy, patients must find alternative ways to store and remove urine.
What are the options for urine storage and elimination after a cystectomy?
Following a cystectomy, patients can no longer store or eliminate urine in the traditional manner. However, there are several options to help manage urine flow:
Ileal Conduit (Urostomy)
- The most common method after a radical cystectomy, ileal conduit involves using a segment of the small intestine (ileum) to create a new pathway for urine to exit the body.
- A small opening, called a stoma, is created in the abdomen, and urine drains into a colostomy bag worn on the outside of the body.
- This method is simple and effective, but it requires lifelong use of a stoma bag.
Neobladder
- In a neobladder reconstruction, a new bladder is created from a segment of the small intestine. This neobladder is surgically connected to the urethra, allowing for voluntary urination.
- The patient can void urine naturally through the urethra after learning to use the neobladder properly. This option offers a more natural method of urination but may require learning new techniques and undergoing regular follow-ups.
Continent Urinary Diversion
- A continent diversion, like the Indiana pouch or Kock pouch, creates a reservoir using part of the intestine. The reservoir stores urine, and patients can empty it via a catheter inserted into the stoma several times a day.
- This option eliminates the need for an external bag, and patients can manage their urinary needs more discreetly.
Each of these options has its benefits and challenges. The choice of urinary diversion method is usually based on the patient’s overall health, preferences, and the recommendation of their medical team.
How does living without a bladder affect daily life?
Life after a cystectomy involves adapting to changes in how the body handles urine elimination. Here’s what to expect:
Physical Adjustments
- Urinary diversion management: Patients must learn how to manage their chosen method for urine storage and elimination. For those with a stoma, this includes learning to change the bag, manage skin care around the stoma, and maintain cleanliness.
- Neobladder care: If the patient has had neobladder reconstruction, they must practice techniques for bladder emptying, and it may take some time to regain full control.
- Increased fluid intake: With a neobladder or ileal conduit, patients will likely need to adjust their fluid intake to ensure proper hydration and bladder function.
Dietary Considerations
- After cystectomy, certain dietary changes may be needed:
- High-fiber diet: To prevent constipation and maintain healthy bowel function, especially when an ileal conduit or neobladder is used.
- Adequate fluid intake: This is important to prevent dehydration and promote the proper function of the urinary diversion system.
Physical Activity and Exercise
- After the surgery, recovery may involve taking things slowly, especially with an ileal conduit, as the body adjusts to the new urinary system.
- Once healed, most patients can return to physical activity, including walking, swimming, and even sports. However, they may need to modify certain activities to avoid straining the stoma or catheter.
What are the psychological effects of living without a bladder?
Undergoing a cystectomy can be emotionally challenging. Adjusting to life without a bladder, especially for younger individuals, can lead to feelings of:
- Body image changes: Patients may feel self-conscious about the stoma or the need to wear a urostomy bag.
- Sexual health concerns: Sexual function may be affected, particularly for men, who may experience erectile dysfunction after surgery. Women may face vaginal changes or concerns about fertility.
- Depression or anxiety: The physical changes and need to adapt to a new lifestyle can trigger emotional distress, though many find coping strategies and emotional support.
It’s important for patients to seek counseling or support groups where they can talk to others who have undergone similar experiences.
What are the risks and complications associated with living without a bladder?
Although modern surgical techniques have made living without a bladder more manageable, there are still risks and complications associated with the procedure:
- Infection: Infections in the stoma or urinary tract are possible, especially with an ileal conduit. Patients need to take care with hygiene and follow their healthcare provider’s instructions.
- Stoma problems: Skin irritation, leaks, and issues with the urostomy bag can occur, requiring proper care and routine maintenance.
- Kidney problems: If the urinary diversion is not functioning properly, it can lead to kidney damage over time.
- Bowel problems: Since parts of the bowel are often used to construct the neobladder or urinary diversion, patients may experience digestive issues, including constipation or diarrhea.
Regular follow-up appointments with healthcare providers are critical to managing these risks and ensuring the proper functioning of the urinary diversion system.
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What is the long-term outlook for people living without a bladder?
Living without a bladder is a significant change, but with proper care and lifestyle adjustments, many patients go on to lead healthy, active lives. The key to long-term success includes:
- Regular follow-ups: Routine check-ups are essential for monitoring the health of the urinary diversion system, checking for any complications, and ensuring there is no recurrence of cancer.
- Psychosocial support: Emotional and psychological support through counseling or support groups helps individuals adjust to their new lifestyle.
- Self-care education: Learning how to properly care for the urinary diversion system and the stoma is critical for maintaining health and comfort.
With these measures in place, patients can live fulfilling lives and continue to enjoy activities they participated in before surgery.
How can a person adjust to the emotional and psychological challenges of living without a bladder?
Adjusting emotionally and psychologically to life without a bladder is a process. Here are some ways to cope:
- Support groups: Joining support groups, whether in person or online, provides a platform to share experiences and learn from others who have faced similar challenges.
- Counseling: Speaking with a mental health professional or counselor who specializes in chronic illness or body image issues can help individuals process their emotions and develop healthy coping mechanisms.
- Communication with loved ones: Open communication with family and friends about concerns and emotional struggles can provide comfort and encouragement.
By addressing both the physical and emotional aspects of recovery, patients can lead fulfilling lives post-cystectomy.
Conclusion
Living without a bladder after a cystectomy requires significant adaptation. From managing the urinary diversion method to coping with emotional challenges, it is a journey that requires support, education, and time. However, with advancements in surgical techniques like robotic cystectomy and neobladder reconstruction, many patients can live fulfilling and active lives post-surgery.
By seeking proper medical care, psychological support, and lifestyle adjustments, individuals can effectively manage life after cystectomy and lead lives free from the burden of bladder cancer.
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PARTIAL PENECTOMY
- Partial penectomy is done in cases where glans and distal penis is involved with carcinoma.
- Partial penectomy is a type of organ-preserving surgery. Preservation of sexual and micturational function depends on the surgical dissection and reconstruction of residual urethra.
Kidney Stone Removal
- Patients who develop stones in the kidney or ureter, often experience severe pain.
- This condition usually needs a procedure to remove the kidney stones.
- This procedure is called ureteroscopy and is performed very commonly.
- It does not require any cuts and hence it is painless.
- The procedure is performed with an endoscope inserted through the penis under spinal anesthesia.
- The scope is inserted through the penis into the kidney and stones are dissolved with a laser.
- The procedure takes about 40-50 minutes.
- A catheter (urine pipe) is kept after the procedure to drain the bladder. A stent is kept in the kidney at the same time.
- Patient is mobile and walking in the room the same evening.
- Hospital stay is one night and patient is discharged the next day after removal of the catheter.
- Patient has to come back after six weeks to remove the stent in the kidney.
- Patients can resume office a week after surgery and heavy activities like running, weight lifting, a month after the procedure.
- We offer fixed packages for this procedure which can be obtained by calling our helpline +91 9967666060.
- Men with an enlarged prostate, which is a normal ageing changes, often experiencing difficulty passing urine. This condition usually needs a procedure to trim the prostate and relieve the blockage.
- This procedure is called TURP and is performed very commonly.
- It does not require any cuts and hence it is painless.
- The procedure is performed with an endoscope inserted through the penis under spinal anaesthesia.
- The overgrown prostate is dissolved with a laser bloodlessly.
- The procedure takes about 40 minutes.
- A catheter (urine pipe) is kept after the procedure to drain the bladder.
- Patient is mobile and walking in the room the same evening.
- Hospital stay is two nights and patient is discharged with the catheter, which is removed after 4 days.
- Patients can resume office a week after surgery and heavy activities like running, weight lifting, a month after the procedure.
- We offer fixed packages for this procedure which can be obtained by calling our helpline +91 9967666060.
ROBOTIC ADRENALECTOMY FOR ADRENAL GLAND TUMOUR
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Robotic adrenalectomy is a sophisticated, complex surgery and it is very important that an experienced surgeon performs this surgery to avoid major complications.
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Once the anesthesia is done, and patient positioned, three micro cuts (3mm each) are made in the patient’s abdomen.
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The arms of the Da Vinci robot are connected to the cuts via ports (tubes).
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Dr. Ramani then sits in the controlling console to perform the surgery.
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On an average, a robotic adrenalectomy takes one hour.
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The surgery is almost completely bloodless and there has never been any need to transfuse blood after surgery.
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A urine catheter and bag to drain the bladder is inserted during surgery.
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A tiny drain pipe may be inserted in the surgical side of the abdomen, connected to a bag.
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Patient is kept nil-by-mouth the day of the surgery, with IV fluids. Sips of water are started the next day and solid food by day three.
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The drain pipe, if kept, is removed in the room on day 2 after surgery.
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The catheter is removed on day two after surgery.
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Total hospital stay for robotic adrenalectomy is 4 nights (including night before surgery).
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Post discharge, a doctor from the surgical team visits the patient at home/ hotel room once every day.
RETURN TO ACTIVITY
On the day of discharge, patient is totally self-sufficient. They are able to walk freely without any pain, dress themselves, shower, toilet and they do not need to hire any nurse or help at home. Almost all patients are back to work within 2 weeks of surgery.
Heavy activities like running, weight lifting can be resumed after a month
FOLLOW UP AFTER SURGERY
Follow up after an adrenalectomy is in the form of CT scans, once a year for 5 years.
Local patients usually meet Dr. Ramani after two weeks to discuss report.Outstation patients are counselled on a phone consultation.
ROBOTIC SURGERY FOR BLADDER CANCER
- Dr. Ramani is one of the very few surgeons in India who has the expertise to perform a robotic surgery for bladder cancer, which includes removing the urinary bladder and reconstructing a new bladder robotically.
- Robotic radical cystectomy is an extremely sophisticated, complex surgery and it is very important that an experienced surgeon performs this surgery to avoid major complications.
- Once the anaesthesia is done, and patient positioned, six micro cuts (3mm each) are made in the patient’s abdomen.
- The arms of the Da Vinci robot are connected to the cuts via ports (tubes).
- Dr. Ramani then sits in the controlling console to perform the surgery.
- On an average, a robotic radical cystectomy with an ileal conduit takes 3-4 hours.
- The surgery is almost completely bloodless and there has never been any need to transfuse blood after surgery.
- A urine catheter and bag to drain the new bladder is inserted during surgery.
- Two tiny drain pipe in inserted in the surgical side of the abdomen, connected to a bag.
- Patient is kept nil-by-mouth for 4 days after surgery with IV supplementation of patient’s daily requirements of calories, fats, carbohydrates, proteins and electrolytes.
- The drain pipes are removed in the room on day 3-5 after surgery.
- Total hospital stay for radical cystectomy is 8 nights (including night before surgery).
- Post discharge, a doctor from the surgical team visits the patient at home/ hotel room once every day.
RETURN TO ACTIVITY
- On the day of discharge, patient is totally self-sufficient. They are able to walk freely without any pain, dress themselves, shower, toilet and they do not need to hire any nurse or help at home.
- Almost all patients are back to work within 6 weeks of surgery. Heavy activities like running, weight lifting can be resumed after two months.
FOLLOW UP AFTER SURGERY
Follow up after a radical a cystectomy is in the form of CT scans, once a year for 5 years.
Histopathology report: Local patients usually meet Dr. Ramani after two weeks to discuss report.
Outstation patients are counselled on a phone consult. Depending on the report, patient may or may not need chemotherapy after surgery.
If chemo is needed, patients may choose to get it done with a medical oncologist of their choice or avail the services of one of the four medical oncologists on our team.
ROBOTIC RADICAL/PARTIAL NEPHRECTOMY FOR KIDNEY CANCER
- Robotic partial nephrectomy is a sophisticated, complex surgery and it is very important that an experienced surgeon performs this surgery to avoid major complications. Robotic radical (total) nephrectomy is
- relatively easier but still requires significant experience to consistently deliver results.
- Once the anaesthesia is done, and patient positioned, five micro cuts (3mm each) are made in the patient’s abdomen.
- The arms of the Da Vinci robot are connected to the cuts via ports (tubes).
- Dr. Ramani then sits in the controlling console to perform the surgery.
- On an average, a robotic radical nephrectomy takes one hour and a robotic partial nephrectomy takes about an hour and half.
- The surgery is almost completely bloodless and there has never been any need to transfuse blood after surgery.
- A urine catheter and bag to drain the bladder is inserted during surgery.
- A tiny drain pipe in inserted in the surgical side of the abdomen, connected to a bag.
- Patient is kept nil-by-mouth the day of the surgery, with IV fluids. Sips of water are started the next day and solid food by day three.
- The drain pipe is removed in the room on day 3 after surgery. The catheter is removed on day two after surgery.
- Total hospital stay for radical/partial nephrectomy is 4 nights (including night before surgery).
- Post discharge, a doctor from the surgical team visits the patient at home/ hotel room once every day.
RETURN TO ACTIVITY
- On the day of discharge, patient is totally self- sufficient.
- They are able to walk freely without any pain, dress themselves, shower, toilet and they do not need to hire any nurse or help at home.
- Almost all patients are back to work within 2-3 weeks of surgery.
- Heavy activities like running, weight lifting can be resumed after a month.
FOLLOW UP AFTER SURGERY
- Follow up after a radical/partial Nephrectomy is in the form of CT scans, once a year for 5 years.
- Local patients usually meet Dr. Ramani after two weeks to discuss report.
- Outstation patients are counselled on a phone consultation.