A radical cystectomy is major surgery and as such has serious potential risks. Keep in mind, however, that the goal of surgery is to cure you of cancer. As such, minor complications are not uncommon, and major complications are possible.
Up to one third of all patients will have at least one complication early on. You should talk to your doctor about the risks for you personally, as they vary greatly depending on your health and other medical problems. Not surprisingly, younger, healthier patients tend to have fewer problems than do older patients with more medical issues.
Bleeding: As with any surgery, there is a risk of bleeding during the operation. Many patients will require blood transfusions. If for religious or personal reasons you cannot accept a blood transfusion, talk with your doctor directly before making a decision about the surgery. Some patients may be able to “donate” their own blood a few weeks before surgery. Then, if they require a blood transfusion, they can be transfused with their own blood.
Infection: The most common types of infection after any surgery are pneumonia and wound infections. Most pneumonia can often be treated with antibiotics, though some more severe cases may require prolonged intubation or stays in the ICU. Wound infections are generally treated by opening the incision slightly and placing a wick into the infected area to let the infection drain out. Antibiotics also are routinely used for wound infections. Abscesses, localized collections of pus, within the abdomen may require placement of a small drainage tube by a radiologist to drain the pus.
Damage to adjacent organs: In order to perform the operation, healthy body parts must be moved out of the way. During the surgery, there is occasionally damage to these structures such as the rectum, blood vessels, spleen, liver, etc. Injuries recognized at the time of surgery can usually be repaired immediately. Occasionally, the injury is not recognized until a day or two after the surgery. This could then require another operation to repair the injury.
Cardiac: The surgery can often take 6 to 12 hours, during which time your heart must perform extra work. Most people will tolerate this easily, but a few (2% to 5%) will have heart problems such as congestive heart failure or even a heart attack. Your doc-tor and the anesthesiologist will evaluate you before surgery to minimize the risk and may even order heart tests such as echocardiograms, stress tests, or cardiac catheterizations to evaluate your cardiovascular status before surgery.
Anesthesia: During the surgery, you will be under anesthesia with a tube inserted to breathe for you. Usually, this tube is removed at the end of surgery to allow you to breathe on your own. Sometimes this tube needs to stay in for a short period of time after the surgery, especially if you have a lot of extra fluid in your body or if you have a preexisting lung condition such as asthma, chronic obstructive pulmonary disease, or emphysema.
Bowel: A piece of small or large intestine is used to make the bladder substitute. Your surgeon needs to reconnect the remaining intestine after this. It is a delicate portion of the procedure, and this repair can occasionally (5% to 10%) leak or obstruct the intestine. These complications usually require a second operation, but some will heal without surgery. Also, anytime an operation is performed in the abdomen, scar tissue (adhesions) will form. These adhesions may sometimes cause pain or bowel obstruction months or years later.
Urinary: Similarly, the new bladder substitute must be stitched together. Despite our best efforts, a few of these will leak urine. After surgery, you will have at least one or two drains left in place, and these drains are often enough to give the leak time to heal on its own. Rarely, if the leak fails to resolve, a second surgery can be required to fix it.
Blood clots: When a blood clot occurs in a large vein of the leg or pelvis, it is referred to as a deep venous thrombosis (DVT). These blood clots may cause swelling of one or both of the legs. The real danger with DVT is that a piece of the blood clot can break off and travel to the lungs. It then gets trapped in the blood vessels of the lungs, preventing blood flow through that section of the lung. This is called a pulmonary embolus and can be a fatal complication. If a DVT is identified, you will usually be placed on blood thinners for several months until the clot has dissolved.
Hernia: A hernia is a weakening of the fibrous layer of the abdominal wall called the fascia. A weakness in the fascia can be seen as a bulging during straining. The abdominal contents that bulge into this pocket can occasionally become trapped or incarcerated. An incarcerated hernia is an emergency that needs to be treated with surgery. To avoid this situation, most hernias will need to be repaired with a procedure that places a synthetic mesh screen behind the fascia to reinforce it, preventing the bulging.
Sexual dysfunction: This may affect both men and women after surgery. Women often experience decreased sexual desire (libido) or vaginal dryness because of hormonal changes and may have pain with intercourse (dyspareunia), especially early after surgery. In men, the incidence of erectile dysfunction after a cystectomy is similar to the rate after removal of the prostate for prostate cancer.
In patients with normal erections preoperatively, up to 70% will regain erections after surgery if attempts are made to pre-serve the nerves going to the penis. Many men with bladder cancer already have some degree of erectile dysfunction, however, before surgery. The return of erections after surgery in these men will not be as good. The same options that are available to men with erectile dysfunction after prostate cancer surgery are available to men with erectile dysfunction after bladder cancer surgery (see Questions 75 and 76 for more details) .
Any of these complications are made more common in patients with poor nutrition. To heal properly, the body needs a ready supply of energy and nutrients. In the days immediately after surgery, the bowels do not function, and you will not be allowed to eat. Most people will begin taking liquids again 3 to 5 days after the surgery. Your body has enough reserves for this amount of time.
Some people, however, will take longer for their bowel function to return and may require intravenous nutrition (called total parenteral nutrition). In the weeks before surgery, it is very important to pay close attention to nutrition. Many patients benefit from protein shakes and other nutritional supplements.
Finally, there is the potential for complications further down the road. Most of these relate to the bladder substitute; thus, we discuss them in more detail when we go over each option.