Radical Cystectomy

Radical cystectomy is a major surgical procedure that involves the removal of the entire bladder and nearby lymph nodes as a treatment for bladder cancer. In men, the procedure typically includes removal of the prostate and seminal vesicles, while in women, it may involve removal of the uterus, ovaries, and part of the vagina. The goal of this procedure is to remove the cancer and prevent its spread.

Indications

Radical cystectomy is primarily indicated for:

Muscle-invasive bladder cancer that has penetrated the muscle layer of the bladder wall.
High-grade, non-muscle invasive bladder cancer that has not responded to other treatments, such as bacillus Calmette-Guérin (BCG) therapy.
Recurrent or extensive non-muscle invasive cancer where less invasive procedures are not effective.

Procedure

The procedure can be performed using traditional open surgery, laparoscopically, or using robotic-assisted techniques. The choice depends on the patient's overall health, the extent of the cancer, and the surgeon’s expertise.

Open Radical Cystectomy: Involves a single, long incision in the abdomen to access and remove the bladder and other organs.
Laparoscopic Radical Cystectomy: Performed through several small incisions using long instruments and a camera to guide the surgery.
Robotic-Assisted Radical Cystectomy: Utilizes a robotic system which the surgeon operates from a console, providing more precision and potentially less blood loss and quicker recovery.

Urinary Diversion

After the removal of the bladder, urine must be redirected since it can no longer be stored in the body. There are several options for urinary diversion:

Ileal Conduit: The most common method where the ureters are connected to a small piece of intestine that is brought to the outside of the abdomen to form a stoma. Urine drains into an external bag.
Neobladder: A new bladder is created from a piece of intestine. This option allows patients to urinate in a more natural way, although it may require self-catheterization if the neobladder does not empty completely.
Indiana Pouch: An internal reservoir is created from the intestine, with a catheterizable stoma on the abdominal wall. This method also requires periodic self-catheterization to drain urine.

Risks and Complications

Infection
Bleeding
Urinary leaks from the sites where the ureters are attached to the bowel
Erectile dysfunction in men and vaginal changes in women
Changes in bowel function due to the use of intestinal tissue for urinary diversion

Recovery and Outcome

Recovery from radical cystectomy can be extensive, requiring a hospital stay of about a week or longer, with several weeks of home recovery. The outcome and prognosis depend on the stage and grade of the bladder cancer, with earlier stages generally having a better prognosis.

Radical cystectomy remains the gold standard treatment for muscle-invasive bladder cancer, offering the best chance for curing the disease when it is localized to the bladder and has not spread to distant sites.

Dr. Mishra is skilled in both traditional open and minimally invasive approaches, including laparoscopic and robotic-assisted radical cystectomy. His choice of technique is tailored to each patient's specific medical condition, the extent of the cancer, and the patient's overall health to provide the best possible outcomes.

With a solid background in urologic oncology, Dr. Mishra’s patients benefit from his extensive experience and commitment to achieving the best clinical and quality-of-life outcomes. His meticulous surgical techniques, combined with a compassionate approach to care, make him a trusted choice for patients undergoing radical cystectomy.

Patients choosing Dr. Mishra for their radical cystectomy can expect a dedicated professional who is committed to providing the highest standard of care in the treatment of bladder cancer.