A radical cystectomy is a surgical treatment in patients most commonly indicated for patients with muscle-invasive bladder cancer.

Indications

• muscle-invasive bladder cancer ⁸

• non-muscle invasive bladder cancer to local treatment (e.g. BCG therapy) ^2,8

• neurogenic or nonfunctioning bladder in some circumstances ^3,4

Contraindications

Relative contraindications for cystectomy include 

• previous pelvic and abdominal radiation

• metastatic or locally advanced urinary bladder cancer (may be considered post-chemotherapy or as a palliative operation) ⁸

Procedure

After obtaining written informed consent, the procedure is performed as an open surgical approach, laparoscopically, or robotically ⁸. This type of surgery involves the removal of the urinary bladder, regional lymph nodes, and the prostate and seminal vesicles in males, and ovarian tubes, ovaries and anterior wall of the vagina in females ¹. After surgery, a urinary diversion is required, most commonly as an ileal conduit ⁸.

Complications

Radical cystectomy has a relatively high morbidity and mortality with a complication rate estimated at ~50% (range 30-70%) and post-operative mortality at ~2% (range 0.8-3%) ⁸. Common complications may relate to the surgical resection and/or urinary diversion:

• ileus, small bowel obstruction, anastomotic leak ⁹

• renal failure, pyelonephritis, abscess ⁹

• urinoma, hematoma, lymphocele ³

Radiographic features

CT/MRI shows non-visualization of urinary bladder and other pelvic organs (depending on patient's sex) in non-complicated, post-surgical status with presence an urinary diversion. Pelvic organs including bowel loops and adjacent omentum may occupy the created space ^5,6. MRI is a better imaging modality than CT in detecting of local recurrent disease ⁷.