Do you need a colostomy bag after bladder removal?

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Quick Answer

Most people do not need a colostomy bag after bladder removal surgery. A colostomy bag collects stool waste and is only needed if the rectum or part of the colon is removed or bypassed. Bladder removal surgery, also called a cystectomy, involves removing the bladder and sometimes nearby organs, but usually the rectum and colon remain intact. However, a small percentage of patients may require a temporary or permanent colostomy after cystectomy due to complications or if part of the rectum is removed.

What is bladder removal surgery?

Bladder removal surgery, also called a cystectomy, is a procedure that removes all or part of the bladder. It is most often done to treat bladder cancer. In some cases, the nearby organs such as the prostate, uterus, ovaries, fallopian tubes, vagina, lymph nodes, and parts of the colon and rectum may also be removed depending on the extent and type of cancer.

There are several types of bladder removal surgery:

Radical cystectomy – removes the entire bladder as well as nearby tissues and organs affected by the cancer.
Partial cystectomy – removes only part of the bladder.
Simple cystectomy – removes only the bladder.

Radical cystectomy is the most common type performed for bladder cancer. In men, the nearby prostate and seminal vesicles are usually removed along with the bladder. In women, the uterus, ovaries, fallopian tubes, cervix, vagina, and part of the vaginal wall may also be removed.

Reasons for bladder removal surgery

The most common reason for bladder removal is to treat bladder cancer. Other reasons include:

Severe bladder damage or problems untreatable by other means.

Birth defects affecting the bladder.
Chronic bladder pain or frequent infections.
Bladder trauma or injury.

End-stage bladder disease like interstitial cystitis.
Bladder complications from radiation or chemotherapy.

For cancer, partial or radical cystectomy may be recommended depending on the type, stage, and grade of the tumor. Early-stage cancers confined to the bladder lining may be treated with partial cystectomy. Invasive or muscle-invasive cancers often require radical cystectomy and removal of surrounding tissue.

Do you need a colostomy after bladder removal?

A colostomy creates an opening called a stoma in the abdomen for stool to bypass the rectum and exit the body into a pouch. This allows the rectum or part of the colon to rest and heal after surgery or injury.

Most people do not require a colostomy after bladder removal alone. The rectum and colon are usually left intact during a standard cystectomy. However, a colostomy may be needed in some cases:

If part of the rectum is removed during radical cystectomy due to cancer spread, a permanent colostomy will be required.

If there are complications like a rectal injury during surgery, a temporary colostomy may be performed to allow healing.
If radiation damage causes a rectal stricture after cystectomy, a diversion colostomy may be placed above the stricture.
If a leak or abscess develops after urinary tract reconstruction, fecal diversion with a colostomy may be done.

Overall, only about 10-15% of people undergoing bladder removal require some form of colostomy or fecal diversion procedure. This may be temporary (several months) or permanent depending on the reason and severity.

Reasons for needing a colostomy after cystectomy

Here are some common reasons a colostomy may be required after bladder removal surgery:

Rectal removal – If invasive bladder cancer spreads to the nearby rectum, a portion of the rectum may require removal during radical cystectomy. This requires permanent fecal diversion with a colostomy.

Damage during surgery – In some cases, the rectum, colon or back passage may be injured during extensive pelvic dissection. This can lead to a leak, abscess or fistula requiring temporary fecal diversion.
Complications after surgery – Issues like infection, delayed healing, urinary leakage, pelvic abscess or dehiscence could also necessitate colostomy placement after cystectomy.
Radiation damage – Prior pelvic radiation for bladder cancer increases the risk of rectal injury and stricture. This may require a permanent diversion colostomy if the stricture is severe.

Urinary tract reconstruction problems – Difficulty healing or leaks after ileal conduit or neobladder creation may warrant temporary fecal diversion till the urinary tract heals.

The risks are higher for a cystectomy requiring extensive dissection, operating on radiated tissue, urinary tract reconstruction, or already weak sphincter muscles.

Types of colostomy

There are several types of colostomy that may be performed after bladder surgery:

Loop colostomy – The colon is cut and the two cut ends are brought out onto the abdomen. Stool can pass through one opening into a pouch.
End colostomy – The colon is cut and one end is brought out onto the abdomen. The other end is sewn closed or removed. All stool passes out into a pouch.
Double barrel colostomy – The colon is cut and both ends are brought out separately onto the abdomen as two openings or stomas. Stool can pass out of either into pouches.

Ileostomy – The end of the small intestine (ileum) rather than the colon is brought out onto the abdomen to create a stoma. An ileostomy may be done if extensive removal of the colon is required.

The type performed depends on the amount of colon needed to be diverted and whether diversion is temporary or permanent. A loop or double barrel colostomy is often used for temporary diversion. An end or ileostomy may be needed for permanent colon removal.

Colostomy procedures with radical cystectomy

There are some standard colostomy procedures that may be performed along with a radical cystectomy requiring rectal removal or diversion:

Proctocolectomy – Removing the rectum and all or part of the colon. This always requires permanent colostomy.
Abdominoperineal resection (APR) – Removing the rectum, sigmoid colon, and anus. This is typically done for low rectal cancers invading the anal sphincter muscles and requires a permanent end colostomy.
Hartmann’s procedure – Removing the rectum and attaching the remaining colon to the skin as an end colostomy. This may be temporary or permanent.

Low anterior resection – Removing the upper rectum and reconnecting the colon. May require a temporary loop ileostomy during healing.

The type of colostomy procedure needed depends on factors like the location and extent of rectal cancer spread, sphincter involvement, and surgeon preference.

Recovery and adjustment after colostomy

Recovering from both bladder removal and colostomy placement can be challenging. Here’s what to expect:

Hospital stay is usually around 2-3 weeks for open radical cystectomy with colostomy creation.
Restrictions on diet, bathing, activity and lifting may be needed initially to prevent wound dehiscence.
Colostomy output and appearance is monitored to ensure proper function.

Pain medication and laxatives may help with postoperative bowel regulation.
Training is given on colostomy care like pouch changing, stoma cleansing and skin protection before discharge.
It takes most patients about 2-3 months to adapt to life with a colostomy and feel comfortable managing it independently.

For temporary colostomies, a reversal surgery is done after several months to reattach the colon once healing occurs.
Counseling and support groups can help patients cope with depression, body image issues or low self-esteem related to colostomy placement.

With time and practice, most individuals are able to resume normal work and social activities with a colostomy. Proper colostomy management and self-care are key to regaining quality of life.

Outlook and prognosis

When needed, colostomy creation can greatly aid recovery and improve outcomes after extensive bladder removal surgery. With training, support, and self-care, living an active life with a colostomy is entirely possible.

Key factors affecting prognosis after radical cystectomy with colostomy include:

Cancer stage – 5-year survival over 70% for localized bladder cancers versus 30% for metastatic disease.

Response to chemotherapy – Good response to neoadjuvant chemo improves survival.
Surgical margins – Clear margins indicating complete tumor removal leads to better outcomes.
Patient age and health – Younger, healthier patients tend to have better survival.

Urinary reconstruction technique – Certain methods like neobladder creation are associated with fewer long-term complications.

For aggressive or advanced bladder cancers, newer techniques like robotic surgery, enhanced recovery programs, and multimodal treatment can also help improve outcomes after radical cystectomy and colostomy.

Conclusion

While most patients undergoing bladder removal surgery do not require a colostomy, up to 15% may need temporary or permanent fecal diversion for reasons like rectal removal, surgical complications, or urinary tract reconstruction problems.

There are various types of colostomy that may be performed along with radical cystectomy depending on the need for rectal resection and permanent versus temporary diversion. Recovery takes time and adjustment, but proper training, care techniques, counselling and social support can help patients return to active lives.