radical cystectomy
Meaning of radical cystectomy: An operation that removes the bladder entirely, along with neighboring organs, and requires a new route built for urine to leave.
Definition of radical cystectomy
A radical cystectomy is surgery to remove the whole bladder together with the surrounding fat, the nearby lymph nodes and adjacent reproductive organs. In men that usually means the prostate and seminal vesicles; in women it may include the uterus, cervix and part of the vaginal wall. Because urine can no longer be stored, the surgeon also builds a new drainage route.
Why is so much removed?
The word radical describes the extent of the operation, nothing else. Cancer that has grown into the muscle wall of the bladder spreads outward into the fat around it and along the lymph channels leaving it, and it can invade the organs pressed against it. Taking the bladder alone would leave those routes untouched. Removing the surrounding tissue and the pelvic lymph nodes as one specimen offers the best chance of clearing the disease, and it also shows how far the cancer had truly travelled once a pathologist examines what came out. A simple cystectomy, by contrast, removes the bladder and nothing more.
Where does the urine go afterward?
| Diversion | How it works | Effect on daily life |
|---|---|---|
| Ileal conduit | A short length of bowel carries urine to an opening on the skin | Urine drains continuously into an external bag |
| Neobladder | A pouch built from bowel and joined to the urethra | Passing urine in the usual way, after retraining |
| Continent reservoir | An internal pouch reaching a small opening in the skin | Emptied with a catheter several times a day |
| Ureterostomy | The tubes from the kidneys brought straight to the skin | Simplest option, now rarely chosen |
Most of these press bowel into work it was never built for, so salt and acid balance, vitamin B12 levels and stone formation are followed long afterward.
What changes afterward?
Recovery is measured in months rather than weeks, and the alterations are permanent. Sexual function is commonly affected, because the nerves involved run close to the bladder and prostate and lie within reach of the surgery, which is what nerve-sparing technique attempts to limit. Anyone with a bladder rebuilt from bowel has to learn a new way of emptying it, including overnight. Follow-up continues for years, since new cancer can appear in the tubes from the kidneys or in the urethra that remains. The similarly named radical prostatectomy follows the same principle of taking an organ with the tissue around it.
Also known as
Used in a sentence
A radical cystectomy with ileal conduit was planned for muscle-invasive disease.
Good to know
Radical here refers to the extent of tissue removed rather than to the severity of the disease, and every form of urinary diversion permanently changes the way urine leaves the body.
Word origin
Where “radical cystectomy” comes from
Cystectomy joins the Greek kystis, a bladder or pouch, with ektome, a cutting out.