chirurgie reconstructrice après la cystectomie radicale

Complications, Risks and Consequences of cystectomy

Complications, Risks and Consequences of cystectomy
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Bladder removal, cystectomy, and complete urinary reconstruction surgery represent a major surgery that exposes it to a number of complications.

During the operation or in the short term, complications can be related to:

  • Anesthesia, which is often prolonged;
  • Surgical hemorrhage;
  • Thromboembolic complications with phlebitis or pulmonary embolism;
  • Intestinal complications, especially with type of occlusion;
  • Wounds to the neighbourhood organs;
  • Infectious complications of the surgical site.

The consequences of this heavy surgery are usually insured in the post-surgical intensive care unit within the first few days after surgery.

Post-operative pain is usually well controlled with pain medication.


Effects of the intervention on urination

Bladder cancer surgery can affect the way the patient urinates.

If a partial cystectomy has been performed, the remaining bladder capacity may be decreased and urination may necessarily occur more frequently.

If it was a radical and total cystectomy, surgery to reconstruct the urinary tract was necessary.

Continuous or non-continuous urinary diversions can lead to complications such as infection, leakage despite the means of fitting, stone formation and obstruction of the urinary tract.

Physical changes associated with bladder removal and urinary diversion may affect quality of life.


Sexuality after total cystectomy for men

During total cystectomy in men, the prostate and seminal vesicles are also removed solidarily with the bladder.

Since most of the semen consists of the secretion of the prostate gland and seminal vesicles, if the man recovers sexual function after the operation, there is in any case no more semen released at the time of orgasm. The orgasm may indeed persist but is usually “dry”.

This necessarily extensive cancer surgery is often not compatible with preserving the vascular and nerve structures that make it possible to obtain an erection.

However, in some men, erections reappear after this surgery, which may allow the resumption of sexual activity.

The younger the patient, the more likely he or she is to recover usable erections.

The new surgical techniques in favourable cases, allow to realize a preservation of the vascular-nervous strips of the erection analogous to that realized during the radical prostatectomy for prostate cancer.


Sexuality after total cystectomy in women

Bladder removal in women is often accompanied by removal of the genital tract, including part of the vaginal wall.

This reduction in the vaginal cavity can make sexual activity uncomfortable in a number of women. However, it is usually possible to resume complete sexual activity.

Vaginal reconstruction surgery is also possible.

Total cystectomy can also affect a woman’s ability to have an orgasm if there has been damage to the pedicles that run through both sides of the vagina.

If bladder removal is accompanied by removal of the urethra, the clitoris may have lost part of its vascular supply, which may also compromise sexual function.


Sexuality with urinary diversion

The presence of a urinary diversion may affect the sexuality of both partners.

It is important that the pouch be properly secured and emptied before sexual activity to reduce the risk of urine leakage at intercourse.

It is also advisable to choose sexual positions that prevent the partner from facing the pocket directly.