Cystectomy Health Dictionary

Diseases of the URINARY BLADDER are diagnosed by the patient’s symptoms and signs, examination of the URINE, and using investigations such as X-RAYS and ULTRASOUND scans. The interior of the bladder can be examined using a cystoscope, which is a ?breoptic endoscope (see FIBREOPTIC ENDOSCOPY) that is passed into the bladder via the URETHRA.

Cystitis Most cases of cystitis are caused by bacteria which have spread from the bowel, especially Escherichia coli, and entered the bladder via the urethra. Females are more prone to cystitis than are males, owing to their shorter urethra which allows easier entry for bacteria. Chronic or recurrent cystitis may result in infection spreading up the ureter to the kidney (see KIDNEY, DISEASES OF).

Symptoms Typically there is frequency and urgency of MICTURITION, with stinging and burning on passing urine (dysuria), which is often smelly or bloodstained. In severe infection patients develop fever and rigors, or loin pain. Before starting treatment a urine sample should be obtained for laboratory testing, including identi?cation of the invading bacteria.

Treatment This includes an increased ?uid intake, ANALGESICS, doses of potassium citrate to make the urine alkaline to discourage bacterial growth, and an appropriate course of ANTIBIOTICS once a urine sample has been ana-lysed in the laboratory to con?rm the diagnosis and determine what antibiotics the causative organism is likely to respond to.

Stone or calculus The usual reason for the formation of a bladder stone is an obstruction to the bladder out?ow, which results in stagnant residual urine – ideal conditions for the crystallisation of the chemicals that form stones – or from long-term indwelling CATHETERS which weaken the natural mechanical protection against bacterial entry and, by bruising the lining tissues, encourage infection.

Symptoms The classic symptom is a stoppage in the ?ow of urine during urination, associated with severe pain and the passage of blood.

Treatment This involves surgical removal of the stone either endoscopically (litholapaxy); by passing a cystoscope into the bladder via the urethra and breaking the stone; or by LITHOTRIPSY in which the stone (or stones) is destroyed by applying ultrasonic shock waves. If the stone cannot be destroyed by these methods, the bladder is opened and the stone removed (cystolithotomy).

Cancer Cancer of the bladder accounts for 7 per cent of all cancers in men and 2·5 per cent in women. The incidence increases with age, with smoking and with exposure to the industrial chemicals, beta-napththylamine and benzidine. In 2003, 2,884 men and 1,507 women died of bladder cancer in England and Wales.

Symptoms The classical presenting symptom of a bladder cancer is the painless passing of blood in the urine – haematuria. All patients with haematuria must be investigated with an X-ray of their kidneys, an INTRAVENOUS PYELOGRAM (UROGRAM) and a cystoscopy.

Treatment Super?cial bladder tumours on the lining of the bladder can be treated by local removal via the cystoscope using DIATHERMY (cystodiathermy). Invasive cancers into the bladder muscle are usually treated with RADIOTHERAPY, systemic CHEMOTHERAPY or surgical removal of the bladder (cystectomy). Local chemotherapy may be useful in some patients with multiple small tumours.... urinary bladder, diseases of

see cystectomy.... bladder replacement

n. an operation to enlarge the capacity of and to decrease the pressure within the bladder by incorporating a segment of bowel. In a clam cystoplasty, the bladder is cut across transversely from one side of the neck to the other side through the dome (fundus) of the bladder and a length of the ileum, jejunum, or colon is inserted as a patch. In the operation of ileocaecocystoplasty, the dome is removed by cutting across the bladder transversely or sagittally above the openings of the ureters; it is replaced by an isolated segment of caecum and terminal ileum. In ileocystoplasty the bladder is enlarged by an opened-out portion of small intestine. The bladder may be totally replaced by a reservoir constructed from either small or large intestine (see cystectomy).... cystoplasty

n. 1. (in anatomy) a small sac-like structure, especially occurring as an outgrowth of a larger structure. The pouch of Douglas is a pouch of peritoneum occupying the space between the rectum and uterus. 2. (in surgery) a sac created from a loop of intestine and used to replace a section of rectum that has been surgically removed, for example in the treatment of ulcerative colitis (see ileal pouch), or to replace the bladder after *cystectomy.... pouch

see cystectomy.... studer pouch

n. the operation of implanting the ureters into the sigmoid colon (see ureteroenterostomy). This method of permanent urinary diversion may be used after *cystectomy or to bypass a diseased or damaged bladder. The urine is passed together with the faeces, and continence depends upon a normal anal sphincter. The main advantage of this form of diversion is the avoidance of an external opening and appliance to collect the urine; the disadvantages include possible kidney infection, acidosis, and long-term development of cancer of the colon 20–30 years after the procedure.... ureterosigmoidostomy

any of various techniques for the collection and diversion of urine away from its usual excretory channels, after the bladder has been removed (see cystectomy) or bypassed. These techniques include *ureterosigmoidostomy and the construction of an *ileal conduit. Continent diversion, usually after cystectomy, may be achieved by constructing a reservoir or pouch from a section of small or large intestine or a combination of both. This can be emptied by catheterization via a small *stoma and has the advantage over an ileal conduit in not requiring a urinary drainage bag.... urinary diversion