What are the consequences of cystectomy?

Many people have had their bladders removed due to physical reasons, and bladder removal does bring a lot of inconvenience to people's lives. Especially the problem of urine drainage. The first thing to do after cystectomy is urine diversion surgery. Currently, it is mainly divided into external drainage and internal drainage in medicine, which needs to be decided according to the patient's own situation.

1. Effects of cystectomy

After cystectomy, urinary diversion surgery is usually performed to allow urine to flow into a urine collection bag that the patient wears all day. The biggest impact is that you will be dependent on a urine bag for the rest of your life. At present, both at home and abroad, there is a tendency to use the intestine to replace the "bladder". According to plastic surgery methods, a new amniotic sac is made, with the upper end connected to the ureter and the lower end directly connected to the urethra, avoiding the diversion of urine from the abdominal wall skin. This in situ bladder reconstruction surgery has become increasingly popular internationally in recent years. The new "bladder" not only has a certain capacity, but also maintains a low tension. After a certain amount of training, the patient can basically urinate more freely, meeting his or her physiological needs for "normal urination" and significantly improving the patient's quality of life.

2. Urine drainage after cystectomy

There are many ways of urine drainage after total cystectomy currently used in clinical practice, which can be roughly divided into external drainage and internal drainage.

1. External drainage method

External drainage is to drain urine directly outside the body and continuously collect urine through an external urine collection device. The two most commonly used methods are ureterocutaneous fistula method and ileal output tract method. The former directly transfers the ureter from the posterior abdominal wall to the anterior abdominal wall, and through the stoma of the anterior abdominal wall, the urine produced by the kidneys is directly drained out of the body through the ureter; the latter first requires cutting a section of small intestine, then connecting the ureter to one end of this section of small intestine, and then leading the other end of the small intestine out of the anterior abdominal wall. The urine produced by the kidneys needs to pass through the ureter and small intestine, and then flow out of the body. Although the ileal output tract is more complicated and an additional section of small intestine needs to be cut, it is not easy to have common complications in ureterocutaneous fistulas, such as the inability to pull the ureter out of the abdominal wall, contracture of the skin fistula, and retrograde renal pelvic infection. Internal drainage requires using part of the digestive tract as a urine reservoir to excrete urine from the body through the digestive tract.

2. Internal drainage method

There are many ways of internal drainage. The earliest method of internal drainage is "urine-fecal combined drainage", which is to drain urine directly into the intestines, store urine through the intestines, and finally the patient excretes urine through the anus in the form of defecation. However, this method has now been basically eliminated due to many complications. : : : : : : : : : : : : : : :

It can be seen that modern medicine has designed many alternative methods for patients who undergo total cystectomy. Although these methods vary greatly and each has its own advantages and disadvantages, each patient can only accept one of them. Usually, urologists will choose the most suitable surgical method for the patient based on the patient's disease status, lifestyle, concomitant diseases, etc. Sometimes the doctor will seek the patient's opinion before the operation to determine the final method of urine drainage.