Radical Cystectomy in Women: Risks, Recovery, and Alternatives

What Is Radical Cystectomy in Women?

For women, a radical surgery is a surgery that changes their lives. A standard radical cystectomy in women includes the removal of various organs like the bladder, uterus, ovaries, fallopian tubes, urethra, and anterior vaginal wall. It affects their urinary, sexual, and reproductive functions. Apart from these, radical cystectomy affects the nerve bundle and artery, causing poor functional outcomes. Neurovascular bundle damage occurs during the surgery. Also, blood supply to the clitoris is affected, causing decreased sensation. All these damages might cause dryness of the vagina, loss of sexual function, and reduced bladder control.

Doctors are aware that radical cystectomy affects major functions, and to overcome it, they have come up with an advanced approach called RO-preserving RC (ROPRC). Rather than removing everything in the pelvic area, ROPRC focuses on preserving vital structures to improve function after surgery. This surgery protects the pelvic nerves that are essential for bladder control and sexual activity. Sometimes, doctors may try to preserve the vagina, ovaries, uterus, and fallopian tubes. This helps to maintain the hormonal balance in younger women.

Thus, by saving these structures, ROPRC can help you maintain good bladder control, avoid urine leakage, improve sexual performance, and maintain hormone balance, which decreases menopause symptoms. It is revolutionary for women who wish to maintain their quality of life while having their bladder removed. If you have to undergo bladder removal surgery, speak with your doctor to know whether ROPRC can be an option for treatment.

How to Prepare for Surgery?

Radical cystectomy preparation can be scary, but knowing about the procedure can help you feel better.

• Inform your doctor about your medications, including vitamins, over-the-counter drugs, and herbal supplements. Also, inform your doctor if you are taking blood thinners like aspirin because these medications disturb the clotting process. Your doctor may advise stopping the medication a day before the surgery.

• You will be instructed not to eat or drink the night before the surgery. If you must take medications, take them with a small sip of water. Keeping your stomach empty helps to prevent complications.

• Sometimes, your doctor may instruct you to prepare your bowel for the procedure. This involves following a liquid diet for a day or two before the surgery. You will also be given laxatives or an enema to clear your bowels.

• Your doctor might advise you to take certain preoperative tests for bladder surgery.

What Happens During the Surgery?

A team of doctors, including a urologist, an anesthesiologist, and nurses, will carry out the surgery during the procedure. An anesthesiologist will give you an anesthetic medication to make you sleep so that you will not feel any pain during the procedure. Your urologist will begin with the surgery to remove your bladder, either by doing a simple cystectomy, where all of the bladder is removed, or a radical cystectomy, where your bladder and surrounding structures like lymph nodes, uterus, or prostate (based on the gender of the patient), etc., are removed.

Once the bladder is removed, your doctors design a new urinary diversion to store and excrete the urine. It includes three ways.

• Ileal Conduit - During this procedure, your urologist removes a small portion of the small intestine (ileum) and attaches it to the ureter. The ureter is a tube-like structure that connects the kidney and the bladder. One end of the dissected small intestine is connected to the ureter, and the other to the stoma (a small opening on the belly's surface). There, it is connected to an ostomy bag (plastic bag) where urine is collected and can be emptied when needed.

• Continent Cutaneous Diversion - In this procedure, your treating doctor creates a small storage pouch (reservoir) inside your body using a part of the small or large intestine. One end of the reservoir is connected to the bladder, and the other end is connected to the stoma. You must periodically remove the urine collected from the reservoir using a catheter a few times a day. Using this technique, you will not require an ostomy bag to collect the urine.

• Neobladder - This is another technique, where your doctor uses a larger section of the small intestine to create a reservoir. One end of it is connected to the ureter, and the other end is connected to the urethra. To eliminate the urine from the newly constructed reservoir, you must work on your pelvic or abdominal muscles to relax and tighten them. Also, some individuals may require a catheter to empty the urine from their neobladder. Though these procedures are helpful, they have some aftereffects, right? So, neobladder side effects can be managed by drinking plenty of water, practicing pelvic floor exercises, etc.

What Happens After the Surgery?

Once the surgery is over, your doctor will suture your incisions and protect them with bandages. Also, your anesthetic medicines will be stopped, and you will regain consciousness.

Adverse Effects:

Urinary diversion complications include infection, kidney issues, constipation, skin irritation, and electrolyte imbalances. If you face any of these, report it to your doctor immediately. And you will be managed with painkillers or antibiotics, diet changes, and medications.

Managing Long-Term Side Effects:

Managing long-term side effects like urinary tract infections, stoma complications, bowel obstruction, etc., requires specific lifestyle changes and medications. You must learn to remove your ostomy bag or to insert a catheter to remove the urine from a bag. You must learn pelvic floor exercises to control your pelvic and abdominal muscles. Also, you should drink plenty of water to prevent infection. If you experience pain, irritation, or other complications, consult a doctor immediately.

Are There Alternative Treatments?

The following are some other alternatives to a radical cystectomy.

• Transurethral resection of bladder tumor.

• Radiotherapy.

• Chemotherapy.

Conclusion

So far, we understand how radical cystectomy is performed in women and how the procedure differs from that in men. Also, we learned how radical cystectomy in women affects their sexual and reproductive functions. It will take time to adapt to the new routine with urinary diversion after surgery. Speak with your doctor if you face any complications after the surgery.

Key Takeaway/Note from Icliniq

Radical cystectomy is a major surgery that changes the lives of women undergoing surgery. Their sexual, reproductive, and urinary functions will be disturbed by performing this procedure. You can speak with your doctor before treatment to learn about other options that might suit you. Though the procedure is overwhelming, you will have a team of doctors to assist you during the procedure.