A cystoprostatectomy is a surgical treatment for bladder cancer, particularly when it involves the prostate or becomes locally advanced.
Cystoprostatectomy, a surgery that removes both the bladder and prostate, has been a crucial part of cancer treatment since the late 1800s.
With modern advancements, including smaller incisions and robotic systems, the surgery currently is more precise, leaves smaller scars, and allows individuals to recover more quickly.
A cystoprostatectomy is a surgery typically performed for the treatment of invasive bladder cancer, especially when the cancer has penetrated the muscular layers of the bladder wall.
The procedure combines elements of a cystectomy (the removal of the bladder) and prostatectomy (removal of the prostate gland). When necessary, the surgery may also include the removal of nearby lymph nodes and seminal vesicles, which are structures involved in semen production.
In some cases, a cystoprostatectomy may also be performed to treat prostate cancer that has moved into the bladder.
The primary purpose of a cystoprostatectomy is to address and control invasive bladder cancer, aiming to improve your chances of recovery and prevent the further spread of the disease.
You may choose a cystoprostatectomy when other treatments aren’t enough or don’t work well, and surgery becomes necessary to manage or treat the health condition.
A cystoprostatectomy can be performed in different ways, and the choice of type depends on various factors, including your health, the extent of cancer, and the surgeon’s expertise.
The main types of cystoprostatecomies include:
- Open cystoprostatectomy: An open cystoprostatectomy is the traditional surgical approach in which a large incision is made in your abdomen to access and remove the bladder and prostate.
- Laparoscopic cystoprostatectomy: A laparoscopic cystoprostatectomy is a minimally invasive approach in which small incisions are made, and a laparoscope (a thin, lighted tube with a camera) is used to guide the surgeon in the removal of your bladder and prostate. Laparoscopic surgery typically results in less pain and a faster recovery compared with open surgery.
- Robot-assisted laparoscopic cystoprostatectomy: A robot-assisted laparoscopic cystoprostatectomy is a variation of laparoscopic surgery in which a surgical robot assists the surgeon in performing the procedure. The robot provides enhanced precision and flexibility, allowing for more complex maneuvers with smaller incisions.
Urinary diversion procedures are tailored to the specific needs of each person. The choice of a particular type depends on factors such as your health, lifestyle, and preferences.
Here are some common types of reconstructive surgery and urinary diversion procedures.
Continent cutaneous diversion (Kock pouch or Indiana pouch)
A continent cutaneous diversion method involves using a section of your bowel to form an internal pouch with a valve mechanism for controlled urine release.
To empty the pouch, a catheter is inserted through your abdominal wall. People who prefer not to use an external urostomy bag often choose this.
In an orthotopic neobladder procedure, a new urine reservoir is made from a part of your intestine, linking it to your urethra. The goal is to allow natural urine voiding through your urethral passage.
It’s typically chosen by people who want a more typical voiding function, provided they’re candidates for this type of reconstruction.
Here are some steps you can take to prepare for a cystoprostatectomy:
- Diagnostic imaging: Before surgery, diagnostic CT scans with contrast are conducted to assess the extent of the disease. Alternative imaging options are available if you have contrast allergies or specific renal conditions.
- Health assessment and readiness: Important tests, like a complete blood count and metabolic panel, are done before the surgery. You’ll also get advice from a healthcare professional on how to take care of your urinary stoma after the operation.
- Preoperative procedures: The day before surgery, you’ll follow a clear liquid diet and undergo mechanical bowel preparation. Intravenous antibiotics, such as broad-spectrum cephalosporin and metronidazole, will be administered. Pain management strategies, such as epidural catheter placement, are also done before the surgery.
- Surgical preparation: Clear communication is maintained with the medical team regarding the surgery. Careful positioning is ensured during the 3–5 hour procedure under general anesthesia. Your abdomen will be prepared with a 10% povidone-iodine solution.
Preparing for challenges after the surgery is also important, especially in managing your urinary stoma. Follow any extra instructions the surgical team may give you before or after the operation.
Here are the steps that you can expect for a cystoprostatectomy:
- Get positioned and anesthetized: You’ll be positioned on your back with a slight bend at the pelvic area. The doctors will give you general anesthesia to put you to sleep and relax your muscles for a procedure lasting 4–6 hours.
- Incision and cleanup: The surgeons will make a cut down the middle of your abdomen, from your belly button to the pubic area. The surgical area will be cleaned with an antiseptic solution.
- Bladder and prostate removal: The surgeons will carefully remove your bladder and prostate.
- Urine diversion: Depending on the surgical plan, a urinary diversion will be established. This may involve creating a stoma for an external urostomy bag or internal pouches.
- Close the incisions: After removing the bladder and prostate, the medical team will close the cuts with stitches or staples.
- Recovery: You’ll be closely watched in the recovery area and later moved to a room. The focus will be on managing your pain, watching for any issues, and starting any necessary postoperative care.
Recovering from a cystoprostatectomy means spending some time in the hospital for monitoring and pain management. You’ll be adjusting to changes in managing urination and gradually getting back to your regular routine.
Long-term follow-up appointments will be made to check your overall health and address any concerns or possible risks. Ongoing examinations can help catch any signs of recurrence.
Possible risks related to a cystoprostatectomy include:
- blood clots
- urinary issues
- digestive changes
- anesthetic complications (e.g., respiratory or cardiovascular issues)
- complications with a stoma (if applicable)
- infection or complications in the surgical site
- changes in sexual function or fertility
- emotional challenges, including body image concerns and psychological adjustments
The overall outcome after a cystoprostatectomy can vary based on individual health, the extent of cancer, and the success of the surgical procedure.
Major surgery-related risks were limited. For people with advanced prostate cancer, the procedure, coupled with additional treatments, showed positive 5-year survival rates, improved symptoms, and enhanced quality of life.
The surgery not only improved overall well-being but also effectively addressed pelvic issues, providing relief for advanced prostate cancer involving the bladder.
A cystoprostatectomy is a surgery primarily used for treating invasive bladder cancer, particularly when it spreads deep into the bladder walls. In some cases, the surgery is also used for prostate cancer that has moved into the bladder.
If you’re living with invasive bladder cancer, a cystoprostatectomy offers hope. This surgery can improve outcomes and enhance your quality of life, providing a positive path forward.