Cystectomy - removal of the bladder in IsraelCystectomy - surgical procedure is to remove all or part of the bladder, a muscular organ that performs the function of collecting and storing urine for subsequent removal from the body.

One of the main indications is cancer of the bladder . Once the patient has been diagnosed with the disease, it is important to determine the stage of disease to estimate the amount of tissue that is affected by cancer cells, and selection of appropriate procedures. Superficial tumors (0 or I step), localized in the mucosa of the bladder can be cured by means of non-surgical treatments - chemotherapy or radiation, as well as removed during partial or simple cystectomy . More radical types of surgical intervention used in the presence of a cancerous tumor, which struck the bladder muscle tissue (stage II, III or IV). Muscle-invasive cancer is observed in 90% of cases of this type of cancer.

Also on the operation of removal of the bladder are sometimes prescribed for recurrent non-invasive cancer. If the disease has returned after undergoing radiation therapy patients, carried out the so-called saving cystectomy.

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Learn more about the features of the treatment in Israel are available on pages:

  1. Israel - medical tourism, or the possibility of treatment without intermediaries
  2. How to choose a clinic in Israel - the pros and cons of public and private hospitals

Removal of bladder tumor in Israel - partial cystectomy

During this type of surgery removes only the part of the body where localized tumor. Unfortunately, its implementation is possible only in cases where the cancer has clear boundaries, the cancer cells have not spread to the muscle of the bladder, and the organ is functioning at the same time.

Only 5,8-18,9% of patients with muscle-invasive cancers are candidates for partial cystectomy bladder . Contraindication for surgery of this type are:

  • intraepithelial carcinoma, located on any body segment;
  • multiple primary tumors of the bladder.

During the operation the patient is under general anesthesia. Traditionally in Israel tumor removal bladder is carried out through an incision in the lower abdomen using two approaches: transperitoneal (transperitoneal) and extraperitoneal (ektraperitonealnym). The surgeon performs the resection of malignant neoplasms together with a margin of normal tissue surrounding it (0.8-2 cm) to remove all the cancer cells from the patient, then sutured organ. Also during the procedure can be performed removing the surrounding pelvic lymph nodes. After operation cystectomy Israeli clinics, doctors check the samples for the presence of healthy tissue tumor cells. Specialist to remove the bladder tumor is prostate Leon Agulyansky .

Due to the fact that local recurrence probability is quite high (37-78%), the patient needs regular medical examinations, including visualization and cytology, as well as tsitoskopiyu (every three months for at least two years). Regular CT scans of the pelvic organs and the abdominal cavity is recommended to take place in the first few years after the operation.

Radical cystectomy in Israeli hospitals

Simple or radical cystectomy is the removal of the bladder and surrounding structures affected by malignant cells. This type of surgery is one of the most effective ways of dealing with invasive bladder cancer and has the following indications:

  • If transitional cell carcinoma, when the execution of BCG therapy was not successful.
  • Multiple papillomas of the bladder, the cure of which can not be achieved by other means (Ta, T1).
  • Invasive transitional cell carcinoma of the bladder (T2, T3).
  • Transitional cell carcinoma, hit the prostate gland of the patient (T4a).
  • Squamous cell carcinoma and sarcoma of the bladder.


  • Hemorrhagic diathesis.
  • Inoperable metastatic disease (unless the procedure is performed to relieve symptoms - palliative surgery).
  • Concomitant diseases that preclude surgical intervention (eg, advanced disease of the heart, impaired lung mechanics, as well as elderly patients).

Conducting operations on removal of a tumor of the bladder for the treatment of men and women have differences. If the patient is a male, then the surgeon carries out the removal of not only the main body of the muscle of the excretory system, but also prostate, seminal vesicles and pelvic lymph nodes. In carrying out this type of surgery in women doctor is resection of the bladder, uterus, fallopian tubes, ovaries, anterior vaginal wall and the lymph nodes in the pelvic area. Removed tissue tested for the presence or absence of cancer cells in them.

After a radical cystectomy there is a need in reconstructive operations in the absence of the bladder. They are used in several ways:

1. Creating ileal conduit - for its formation uses small intestine segment extending from one side connects with the ureters, the other - with a urostomy. The result of these manipulations urine from the ureter along conduit in the bag, which is attached to an opening in the abdominal region.

2. orthotopic bladder Education is carried out in two ways.

  1. The first is to provide a most natural way output of urine excreted by a special reservoir created from the small intestine tissue which is attached to one end of the ureter, and the second end thereof is sewn to the urethra.
  2. The second is performed in cases where the entire urethra or a part thereof has been removed input cystectomy bladder lies in the formation of an alternative artificial organ, which on one side is connected to the ureters and, on the other - to the opening in the anterior abdominal wall. Urine output is performed using a special plastic tube - a catheter introduced into urostomy. The advantage of this method is that the patient does not have to wear a plastic bag, and from time to time to empty the tank.

After removal of the bladder and nearby organs for him following complications can occur in patients:


  • urinary incontinence;
  • ileus.


  • Recurrent urinary tract infection;
  • parastomalnaya hernia;
  • ureteral stricture;
  • lymphorrhea;
  • myocardial infarction;
  • acidosis;
  • peritonitis;
  • renal failure;
  • bilateral hydronephrosis.

Also, after surgery in men may experience erectile dysfunction, and women - reduced sexual sensation.

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Laparoscopic and open surgery

Cystectomy bladder - a complex operation whose execution in Israeli clinics can be carried out both minimally invasive and traditional way.

Removal of the bladder open way

Operation (or open abdominal) is performed under general anesthesia, access to the internal organs through a long midline incision in the abdominal cavity, the enveloping navel, in some cases produced cross-sectional view of the abdominal wall. Further removal is carried affected organs and surrounding tissue, and is also formed a new path for urine output (if radical type of surgery).

Laparoscopic cystectomy

This minimally invasive surgery involves the removal of the affected organ together with nearby lymph nodes in the case where the cancer cells have spread to adjacent tissue. If the patient - a man, then the doctor performs a resection of the bladder with the prostate (and other agencies if necessary) through a small incision in the abdominal cavity, if the woman - through an incision in the vaginal wall.

Laparoscopic surgery is performed under general anesthesia. The surgeon makes a small incision of 3-4 in order to be able to resect the bladder. Further, in one of the holes is inserted a tube equipped with a source of light and a video camera, so that the surgeon gets the most accurate magnified image of the surgical field. The incisions are also introduced surgical tools needed for the separation of the bladder from the surrounding tissue. Depending on the stage of the disease completely removed portion and the body, and nearby lymph nodes. Reconstructive surgery is performed, and the incisions are sutured.

As well as after any surgical procedure, laparoscopic surgery there is a possibility of complications:

  • damage to surrounding tissues or organs;
  • bleeding;
  • infection;
  • thrombus formation:
  • urinary incontinence;
  • blocking the flow of urine.

To all the above, you can add that in addition to potential risks the operation minimally invasive way has some obvious advantages:

  1. Short stay in the clinic.
  2. Reduction of post-operative pain.
  3. Small cuts - almost imperceptible scars.
  4. Fast patient / patient's rehabilitation.

robotic cystectomy

Robotic surgery is also performed using laparoscopic techniques, but it has some significant differences. During operation in Israel using da Vinci robotic system, the surgeon performs the robot control using a special console, which is in the same room where the removal is performed and bladder. It is important to understand that the robot is not in itself perform surgical procedures, and the surgeon directs it, which results in more accurate and most effective results.

Da Vinci robot is equipped with a 4 "by hand", one of which holds the 3D camera with multiple zoom images. It is introduced into one of the incisions in the abdomen, allowing the surgeon to see the internal organs of the abdominal cavity, and the remaining 3 "hand" held a variety of surgical instruments, which are produced and various manipulations.

Main advantages of the robotic surgery cystectomy :

  1. The average of 150-500 ml of blood loss, whereas during open surgery blood loss varies from 600 to 3000 ml.
  2. The patient begins to eat and drink a lot sooner than after traditional surgery.
  3. hospitalization time and patient recovery is significantly reduced.

Specific risks robotic cystectomy:

  • damage structures abdominal or rectal;
  • leakage of urine;
  • blocking the flow of urine when it passes a urostomy;
  • the need for open surgery;
  • compression of the nerves;
  • incomplete removal of the cancerous tumor.

The period after the removal of the bladder

Immediately after surgery, the patient can be transferred to the intensive care unit (24-48 hours), which is made carefully monitoring his blood pressure, pulse and other vital signs, or in the recovery room.

To reduce the level of pain it can be used as patient-controlled analgesia, and epidural anesthesia. After 2-3 days the patient begins to take pain medications. nasogastric (removed after a few days) is also input to it, it is carried intravenous drip and intestinal noises performed auscultation with a stethoscope.

Typically, the patient stays in the hospital is about a week, and a full recovery usually takes 6 to 8 weeks. Patients after radical cystectomy can be assigned to subsequent therapy - irradiation or chemotherapy, and after partial removal of the bladder during the initial stages of the disease - immunotherapy.

The high level of medical care in clinics in Israel, the most advanced equipment, the use of high-tech - all this provides the most effective treatment for patients who have been diagnosed with cancer of the bladder. Our team «Tlv.Hospital» will help you to connect with the best Israeli medical institutions, will create the most comfortable living conditions and hospitalization and solve all sorts of related problems.

Cystectomy successfully held in Israeli hospitals minimally invasive way - through laparoscopy, which significantly reduces the risk of complications, pain, promotes rapid rehabilitation. In addition, it is possible to perform operations using the da Vinci robot, thanks to her made the maximum accuracy and efficiency, the amount of blood loss is reduced and the period of hospitalization and recovery.

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