What is Bladder Removal Surgery (Cystectomy): Purpose, Procedure, Results, Preparation & Costs in India

Bladder removal surgery, also known as cystectomy, is a significant surgical procedure involving the removal of all or part of the urinary bladder. For many, the thought of this surgery can be daunting, filled with questions and concerns. This comprehensive guide aims to provide Indian patients and their families with clear, actionable information about cystectomy, covering everything from its purpose and procedure to potential risks, recovery, and costs in India. We understand that navigating medical decisions can be overwhelming, and we hope this information empowers you to have informed conversations with your healthcare providers.

Important Note: This information is for general knowledge and awareness only and does not substitute professional medical advice. It is essential to consult with a qualified medical professional for personalized guidance and treatment options.

Why is a Cystectomy Performed?

The primary reason for a cystectomy is to treat bladder cancer. However, it's also considered for various other conditions affecting the bladder and urinary system. Let's break down the key reasons:

• Bladder Cancer: This is the most common indication for a cystectomy. It's typically recommended when the cancer has invaded the muscle layer of the bladder, is considered high-grade (aggressive), or has recurred despite initial treatments like chemotherapy or radiation.
• Congenital Urinary System Issues: In some cases, individuals may be born with abnormalities in their urinary system that necessitate bladder removal.
• Neurological or Inflammatory Conditions: Conditions like neurogenic bladder (bladder dysfunction caused by nerve damage) or severe interstitial cystitis (chronic bladder pain) can, in rare instances, lead to cystectomy if other treatments fail to provide relief.
• Radiation-Related Complications: Radiation therapy for cancers in the pelvic area (e.g., prostate, cervical, rectal) can sometimes damage the bladder, leading to complications that require cystectomy. This is known as radiation cystitis.
• Non-Cancerous Conditions: In rarer scenarios, cystectomy may be considered for conditions like:
  • Urinary Fistula: An abnormal connection between the bladder and another organ (e.g., vagina, bowel).
  • Severe Urinary Dysfunction: When the bladder is severely damaged or dysfunctional, making normal urination impossible.
  • Excessive Bleeding from the Bladder: In cases where other treatments to control severe bleeding from the bladder are unsuccessful.

Who Needs a Cystectomy? Determining Candidacy

The decision to undergo a cystectomy is a complex one, made after careful evaluation by a multidisciplinary team of doctors, including urologists, oncologists, and other specialists. Factors that influence this decision include:

• The Stage and Grade of Bladder Cancer: The extent of the cancer's spread and its aggressiveness are crucial factors.
• The Patient's Overall Health: The patient's general health, age, and any other existing medical conditions are considered to ensure they can tolerate the surgery and recovery.
• The Patient's Preference: Ultimately, the patient's wishes and understanding of the risks and benefits of the procedure are paramount.

Preparation for Cystectomy in India: Practical Tips

Preparing for a cystectomy involves several steps to ensure the best possible outcome. Here's a guide tailored for Indian patients:

• Thorough Medical Evaluation: Expect a comprehensive evaluation, including physical exams, blood tests, urine tests, imaging scans (CT scans, MRI scans), and possibly a cystoscopy (a procedure to visualize the inside of the bladder). Discuss your complete medical history, including any allergies, previous surgeries, and current medications, with your doctor.
• Medication Review: Inform your doctor about all medications you are taking, including prescription drugs, over-the-counter medications, herbal remedies, and supplements. Some medications, such as blood thinners (e.g., warfarin, aspirin), may need to be stopped several days before surgery to reduce the risk of bleeding.
• Lifestyle Modifications:
  • Quit Smoking: Smoking significantly increases the risk of surgical complications, including poor wound healing and respiratory problems. If you smoke, quitting is crucial before surgery. Seek help from your doctor or a smoking cessation program.
  • Optimize Nutrition: A healthy diet rich in protein, vitamins, and minerals can help improve your overall health and prepare your body for surgery. Consult with a registered dietitian for personalized dietary recommendations.
  • Manage Underlying Health Conditions: Ensure that any underlying health conditions, such as diabetes or heart disease, are well-managed before surgery.
• Bowel Preparation: Your doctor may prescribe antibiotics to reduce the risk of infection and laxatives or enemas to clean out your bowels before surgery. This helps prevent complications related to bowel function after surgery. Follow your doctor's instructions carefully.
• Fasting: You will typically be instructed to not eat or drink anything after midnight on the day of your surgery. This is important to prevent complications related to anesthesia.
• Pre-operative Consultations: Meet with your surgeon, anesthesiologist, and other members of your care team to discuss the procedure in detail, address any concerns you may have, and review pre-operative instructions.
• Arrange for Support: Cystectomy is a major surgery, and you will need support during your recovery. Arrange for a family member or friend to stay with you at the hospital and at home after discharge.
• Financial Planning: Discuss the estimated cost of the surgery, hospitalization, and post-operative care with your hospital's billing department. Explore options for financial assistance, such as health insurance, government schemes, or charitable organizations.
• Mental Preparation: Cystectomy can be emotionally challenging. Talk to your family, friends, or a therapist about your fears and anxieties. Consider joining a support group for bladder cancer patients.

India-Specific Considerations:

• Language Barriers: If you are not fluent in the language spoken at the hospital, consider bringing a translator with you.
• Cultural Sensitivity: Discuss any cultural or religious practices that may affect your care with your healthcare providers.
• Dietary Restrictions: Inform the hospital staff about any dietary restrictions you may have (e.g., vegetarian, vegan, Jain).

Cystectomy Procedure: A Step-by-Step Guide

The cystectomy procedure involves several key steps:

1. Anesthesia: You will receive general anesthesia, meaning you will be unconscious and pain-free during the surgery.
2. Surgical Approach: The surgeon will choose the most appropriate surgical approach based on your individual circumstances:
   • Open Surgery: A single, larger incision is made in the abdomen to access the bladder. This approach is often used for complex cases or when minimally invasive surgery is not feasible.
   • Minimally Invasive Surgery (Laparoscopic): Several small incisions are made in the abdomen. A laparoscope (a thin, telescope-like instrument with a camera) and specialized surgical tools are inserted through these incisions. The surgeon uses the camera to view the inside of the abdomen and perform the surgery.
   • Robotic Surgery: This is a type of minimally invasive surgery where the surgeon uses robotic surgical tools to perform the procedure. The robot provides enhanced precision, dexterity, and visualization.
3. Bladder Removal: The surgeon carefully removes the bladder from the surrounding tissues. In a radical cystectomy, the blood vessels supplying the bladder are cut, and nearby lymph nodes are also removed to check for cancer spread.
   • In men: A radical cystectomy typically involves removing the prostate gland and seminal vesicles along with the bladder.
   • In women: A radical cystectomy may involve removing the uterus, ovaries, fallopian tubes, and part of the vagina along with the bladder.
4. Urinary Diversion: After the bladder is removed, a new way for urine to be stored and eliminated from the body must be created. This is called urinary diversion. There are several options:
   • Neobladder: A section of the small intestine is used to create a new bladder-like pouch inside the body. The neobladder is connected to the urethra, allowing you to urinate in a relatively normal way. However, you may need to learn new techniques to empty the neobladder completely.
   • Urinary Conduit (Ileal Conduit/Urostomy): A short segment of the small intestine is used to create a pathway for urine to exit the body through a stoma (an opening) in the abdomen. A pouching system is then attached to the stoma to collect the urine. This is the most common type of urinary diversion.
   • Continent Urinary Reservoir (Indiana Pouch): An internal pouch is created from a section of the intestine to store urine. You drain the pouch by inserting a catheter through a stoma in the abdomen several times a day. You do not need to wear an external pouch.

The choice of urinary diversion depends on various factors, including your overall health, kidney function, and personal preferences. Your surgeon will discuss the options with you in detail and help you make the best decision for your individual circumstances.

Understanding the Results of Cystectomy

The results of a cystectomy depend on the reason for the surgery and the type of procedure performed.

• Cancer Treatment: If the cystectomy was performed to treat bladder cancer, the primary goal is to remove all traces of the cancer. The removed bladder and lymph nodes are examined under a microscope to determine the extent of the cancer and whether it has spread to other parts of the body. This information helps guide further treatment decisions, such as chemotherapy or radiation therapy.
• Changes in Urination: After a partial cystectomy, the bladder is smaller, so you may need to urinate more frequently. After a radical cystectomy, you will urinate in a different way, depending on the type of urinary diversion you have. It may take time to adjust to the new way of urinating.
• Sexual Side Effects: Cystectomy can cause sexual side effects. Men may have trouble getting aroused or maintaining an erection and will no longer produce semen. Women can also experience sexual side effects, such as vaginal dryness and decreased libido. These side effects can be managed with medication, therapy, or other treatments.
• Recovery: The recovery from cystectomy can be lengthy and challenging. You will likely need to stay in the hospital for 5-14 days. Full recovery may take 8-12 weeks or longer. You will need to follow your doctor's instructions carefully regarding wound care, pain management, diet, and activity level.

Risks Associated with Cystectomy

Like any major surgery, cystectomy carries certain risks. It's crucial to be aware of these risks and discuss them with your surgeon.

• General Surgical Risks:
  • Bleeding: Excessive bleeding can occur during or after surgery, requiring blood transfusions or further intervention.
  • Blood Clots: Blood clots can form in the legs or lungs, leading to serious complications such as deep vein thrombosis (DVT) or pulmonary embolism (PE).
  • Infection: Infections can occur at the surgical site, in the urinary tract, or in other parts of the body.
  • Poor Wound Healing: The surgical incision may not heal properly, leading to infection or other complications.
  • Damage to Nearby Organs or Tissues: There is a risk of damage to nearby organs or tissues, such as the bowel, ureters, or blood vessels.
  • Reactions to Anesthesia: Allergic reactions or other complications can occur in response to anesthesia.
• Risks Related to Urinary Diversion:
  • Ongoing Diarrhea: Some patients experience chronic diarrhea after urinary diversion due to changes in bowel function.
  • Decline in Kidney Function: Urinary diversion can sometimes affect kidney function, leading to kidney damage or failure.
  • Imbalance in Needed Minerals: Electrolyte imbalances can occur after urinary diversion, requiring monitoring and treatment.
  • Vitamin B-12 Deficiency: Vitamin B-12 deficiency is common after urinary diversion because the section of the intestine used to create the diversion is responsible for absorbing vitamin B-12.
  • Urinary Tract Infections: Urinary tract infections are common after urinary diversion because the new urinary system is more susceptible to infection.
  • Kidney Stones: Kidney stones can form in the urinary tract after urinary diversion.
  • Urinary Incontinence: Some patients experience urinary incontinence after urinary diversion, especially with a neobladder.
  • Bowel Obstruction: Bowel obstruction can occur due to scar tissue or other complications.
  • Ureter Blockage: The ureters (tubes that carry urine from the kidneys to the bladder) can become blocked, leading to kidney damage.
• Other Complications:
  • Bowel Complications: Bowel complications, such as bowel obstruction or perforation, can occur.
  • Scar Tissue that Blocks the Flow of Urine from Your Kidneys: Scar tissue can form and block the flow of urine from the kidneys, leading to kidney damage.
  • Fluid Buildup at Surgical Sites: Fluid can accumulate at the surgical sites, requiring drainage.
  • Organ Damage Due to the Body Reacting Poorly to Infection (Sepsis): Sepsis is a life-threatening condition that can occur if the body reacts poorly to an infection.
  • Rarely, Death Linked to Complications from Surgery: Although rare, death can occur due to complications from surgery.

Cystectomy Costs in India: A Detailed Breakdown (₹)

The cost of cystectomy in India can vary significantly depending on several factors. Here's a detailed breakdown to help you understand the potential expenses:

• Average Cost: The average cost of cystectomy in India can range from ₹2,00,000 to ₹6,00,000 (USD 2500 to USD 7000). However, some sources suggest that the cost can be between ₹80,000 to ₹8,00,000 (USD 1,000 to USD 10,000) depending on various factors. For international patients, the cost is approximately between ₹3,00,000 to ₹4,00,000 (USD 3800 to USD 4800).
• Factors Influencing Cost:
  • Type of Cystectomy: Partial cystectomy is generally less expensive than radical cystectomy.
  • Hospital Infrastructure and Reputation: Private hospitals with advanced technology and experienced surgeons typically charge more than public hospitals or smaller clinics.
  • Surgeon's Fees and Experience: Experienced surgeons may charge higher fees.
  • Medical Investigations and Diagnostic Procedures: The cost of pre-operative tests, such as CT scans, MRI scans, and biopsies, can add to the overall expense.
  • Post-Operative Care and Hospitalization Expenses: The length of your hospital stay and the level of care you require will affect the cost.
  • Medication Costs: The cost of medications, such as antibiotics and pain relievers, can also contribute to the overall expense.
  • Patient's Condition and Duration of Treatment: Complex cases or those requiring longer treatment periods may incur higher costs.
  • Geographical Location: The cost of healthcare can vary depending on the city and region in India. Metropolitan cities like Mumbai, Delhi, and Chennai tend to have higher costs.
  • Government Policies and Subsidies: Government-sponsored health insurance schemes may help reduce the cost of cystectomy for eligible patients.
  • Medical Tourism Packages: Medical tourism packages offered by some hospitals may include the cost of surgery, accommodation, and other services.
• Additional Expenses:
  • Pre-Surgery Consultations: Consultation fees for the surgeon, oncologist, and other specialists.
  • Diagnostic Tests: Costs for X-rays, MRI scans, blood tests, and biopsies.
  • Physiotherapy Sessions: Costs for physiotherapy sessions to help with recovery.
  • Medications: Costs for pre- and post-operative medications.
  • Supportive Devices: Costs for supportive devices, such as ostomy supplies (if you have a urostomy).
  • Follow-Up Visits: Costs for follow-up appointments with your doctor.

It's essential to discuss the estimated cost of the surgery and related expenses with your hospital's billing department and explore options for financial assistance.

How Ayu Helps

Ayu is a medical records app designed to help Indian patients manage their healthcare information securely and conveniently. While Ayu doesn't directly provide surgical services, it can be a valuable tool for patients undergoing cystectomy:

• Centralized Medical Records: Store all your medical records, including test results, doctor's notes, and medication lists, in one secure location. This makes it easy to access and share your information with your healthcare providers.
• Appointment Reminders: Set reminders for appointments and medication schedules to stay on track with your treatment plan.
• Medication Tracking: Track your medications, dosages, and side effects to ensure you are taking them correctly and to identify any potential problems.
• Communication with Healthcare Providers: Securely communicate with your healthcare providers through the app to ask questions and receive updates.
• Family Access: Grant access to your medical records to family members who are helping you with your care.

Frequently Asked Questions (FAQs)

Here are some frequently asked questions about cystectomy:

1. What is the survival rate after cystectomy for bladder cancer? The survival rate after cystectomy for bladder cancer depends on several factors, including the stage and grade of the cancer, the patient's overall health, and the quality of surgical care. Early-stage bladder cancer has a higher survival rate than advanced-stage bladder cancer.
2. How long will I stay in the hospital after cystectomy? The typical hospital stay after cystectomy is 5-14 days. However, the length of your stay may vary depending on your individual circumstances.
3. Will I need a stoma after cystectomy? Whether you need a stoma depends on the type of urinary diversion you have. If you have a urostomy, you will need a stoma to collect urine. If you have a neobladder or continent urinary reservoir, you will not need a stoma.
4. Will I be able to have children after cystectomy? Men who undergo radical cystectomy will no longer be able to father children naturally. Women who undergo radical cystectomy may lose their ability to have children depending on whether the uterus and ovaries are removed. Discuss fertility options with your doctor before surgery.
5. What are the long-term side effects of cystectomy? Long-term side effects of cystectomy can include sexual dysfunction, urinary incontinence, bowel problems, and kidney problems. Your doctor can help you manage these side effects.
6. Can I lead a normal life after cystectomy? Yes, most people can lead a normal life after cystectomy. It may take time to adjust to the new way of urinating, and you may need to make some lifestyle changes. However, with proper medical care and support, you can maintain a good quality of life.
7. What is the difference between partial and radical cystectomy? A partial cystectomy involves removing only a portion of the bladder, while a radical cystectomy involves removing the entire bladder and surrounding structures. Partial cystectomy is typically used for early-stage bladder cancer, while radical cystectomy is used for more advanced bladder cancer.
8. Are there any alternatives to cystectomy for bladder cancer? In some cases, there may be alternatives to cystectomy for bladder cancer, such as chemotherapy, radiation therapy, or immunotherapy. However, cystectomy is often the most effective treatment option for muscle-invasive bladder cancer. Discuss all treatment options with your doctor to determine the best course of action for you.
9. How often will I need to follow up with my doctor after cystectomy? You will need to follow up with your doctor regularly after cystectomy to monitor your health and detect any potential problems. The frequency of follow-up appointments will depend on your individual circumstances.

We hope this comprehensive guide has provided you with valuable information about cystectomy. Remember to consult with your healthcare providers for personalized advice and treatment options. Your health and well-being are our priority.