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A cystectomy is the removal of all or part of the urinary bladder.  Most commonly, this procedure is performed to address cancer.   
A cystectomy is the removal of all or part of the urinary bladder.  Most commonly, this procedure is performed to address cancer. May be combined with prostatectomy, ileal conduit, or neobladder reconstruction.   


== Preoperative management ==
== Preoperative management ==
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|Respiratory
|Pulmonary
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=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===
=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===
* 2 PIVs for open, radical, or robotic cystectomy (18g+)


=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===
=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===
* GETA


=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
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=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===
=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===


* If radical cystectomy, have T&S and consider T&C 2 units
* If robotic, patient will be in steep Trendelenburg for a large portion of the case
*If radical cystectomy, have T&S and consider T&C 2 units
* Some centers use indocyanine 25mg to visualize blood flow to the ureters
*If construction of ileal conduit or neobladder, surgeons generally like to keep the patient dry to prevent diuresis and high UOP during the case; liberalize fluid goals after completion of anastamoses


=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===
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=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===
=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===
* PACU


=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===
=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===
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!Open cystectomy
!Open cystectomy
!Minimally invasive cystectomy
!Minimally invasive cystectomy
!Robotic cystectomy
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|Unique considerations
|Unique considerations
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|Involves removal of entire bladder, nearby lymph nodes, part of the urethra, and nearby organs that may contain cancer cells
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|Possible when the cancerous lesion is located in the dome of the bladder. Does not require urinary diversion
|Simple, open cystectomy involves removal of the entire bladder without removal of any adjacent structures or organs. Urinary diversion is then created.
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|Position
|Position
|Supine, sometimes lithotomy for females
|Supine
|Supine, one or both arms out
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|Steep Trendelenburg
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|Surgical time
|Surgical time
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|~ 4-6 hrs
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|EBL
|EBL
|300-1500
|300-1500
|Minimal
|Minimal
|1000mL
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|100-200mL
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|Postoperative disposition
|Postoperative disposition
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|PACU
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|Pain management
|Pain management
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|2
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|Potential complications
|Potential complications
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[[Category:Surgical procedures]]
[[Category:Surgical procedures]]
[[Category:Urology]]

Latest revision as of 08:19, 3 October 2025

Cystectomy
Anesthesia type

General / Neuraxial

Airway

ETT

Lines and access

Partial: PIV x 1 (20)
Radical: PIV x 2 (18 or 16)

Monitors

Partial: Standard
Radical: Std + art line

Primary anesthetic considerations
Preoperative
Intraoperative
Postoperative

hemorrhage, wound infection, DVT, UTI, ureterointestinal leakage, ileus

Article quality
Editor rating
In development
User likes
0

A cystectomy is the removal of all or part of the urinary bladder. Most commonly, this procedure is performed to address cancer. May be combined with prostatectomy, ileal conduit, or neobladder reconstruction.

Preoperative management

Patient evaluation

System Considerations
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Labs and studies

Operating room setup

Patient preparation and premedication

Regional and neuraxial techniques

  • If spinal used, ensure T4 sensory level
    • Consider using epi in spinal to prolong block
  • Can consider placing epidural if significant post-op pain anticipated

Intraoperative management

Monitoring and access

  • 2 PIVs for open, radical, or robotic cystectomy (18g+)

Induction and airway management

  • GETA

Positioning

  • Supine
  • Sometimes females placed in lithotomy

Maintenance and surgical considerations

  • If robotic, patient will be in steep Trendelenburg for a large portion of the case
  • If radical cystectomy, have T&S and consider T&C 2 units
  • Some centers use indocyanine 25mg to visualize blood flow to the ureters
  • If construction of ileal conduit or neobladder, surgeons generally like to keep the patient dry to prevent diuresis and high UOP during the case; liberalize fluid goals after completion of anastamoses

Emergence

Postoperative management

Disposition

  • PACU

Pain management

Potential complications

  • Bleeding

Procedure variants

Radical cystectomy Partial Cystectomy Open cystectomy Minimally invasive cystectomy Robotic cystectomy
Unique considerations Involves removal of entire bladder, nearby lymph nodes, part of the urethra, and nearby organs that may contain cancer cells Possible when the cancerous lesion is located in the dome of the bladder. Does not require urinary diversion Simple, open cystectomy involves removal of the entire bladder without removal of any adjacent structures or organs. Urinary diversion is then created.
Position Supine, sometimes lithotomy for females Supine Supine, one or both arms out Steep Trendelenburg
Surgical time 4-6 hours ~ 2 hours (urinary diversion not required) ~ 4-6 hrs
EBL 300-1500 Minimal 1000mL 100-200mL
Postoperative disposition PACU
Pain management 2
Potential complications

References

Top contributors: Barrett Larson, Olivia Sutton, Sarah Glier, Nirav Kamdar, Chris Rishel and Tony Wang

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