Cystektomie

Cystektomie, or cystectomy, is the surgical removal of the urinary bladder. In oncologic settings it refers to removing the bladder and often adjacent organs. The main forms are radical cystectomy (complete removal of the bladder) and partial cystectomy (removal of part of the bladder) depending on tumor characteristics. Indications include muscle-invasive bladder cancer (usually stages cT2–cT4) and high‑risk non–muscle-invasive disease that does not respond to intravesical therapy. Non-oncologic indications can include severe neurogenic detrusor overactivity or a nonfunctioning bladder with refractory symptoms.

Surgical approach can be open, laparoscopic, or robotic-assisted. Radical cystectomy is typically accompanied by regional lymph node dissection and, in men, removal of the prostate and seminal vesicles; in women, removal may include the uterus, ovaries, and part of the vagina. Because the bladder is removed, urinary diversion is required to store or channel urine. Diversion options include an ileal conduit (ureters connected to a stoma on the abdomen), orthotopic neobladder (a reservoir fashioned from bowel that allows near-normal voiding through the urethra), and other continent reservoirs.

Postoperative care includes stoma or catheter management, monitoring for complications, and rehabilitation. Depending on cancer stage, neoadjuvant or adjuvant chemotherapy may be used; radiotherapy may be an alternative in selected cases. Outcomes depend on tumor stage and the chosen diversion. Cystectomy is a major operation with risks such as infection, bleeding, and urinary or intestinal complications, but it remains a standard treatment for eligible muscle-invasive bladder cancer.