Total cystectomy: the options so far - Is it advisable?

Indications for total cystectomy

Total cystectomy consists of complete removal of the urinary bladder and requires some form of urinary diversion. Total cystectomy remains uncommonly used in small animal surgery but stands as the state-of-theart treatment for management of invasive bladder tumours in humans. Although several cases of total cystectomy due to traumatic injuries and/or subtotal necrosis have been reported in the veterinary literature, the most common indication is for treatment of a neoplasm affecting the urinary bladder, prostate gland and/or the proximal urethra.

Bladder cancer comprises approximately 2% of all naturally occurring cancers in dogs. The vast majority of tumours in the canine and feline population (97% and 80% respectively) are epithelial.

Transitional cell carcinomas (TCC), also referred to as urothelial carcinomas, are categorised by their growth pattern as either papillary or non-papillary (50%) as well as infiltrating (> 90%) or non-infiltrating. TCC is most often located in the trigone region of the bladder but can also affect the urethra (56%) or the prostate (29% in males). TCC are locally invasive, affecting the muscularis layer (T2 stage) in 78% of cases and can spread to the adjacent organs, including the pelvic fat, prostate, uterus, vagina and rectum in 20% of cases (T3 stage). Metastatic spread to the regional lymph nodes is reported in 50% of patients at the time of diagnosis. Distant metastases can occur later in the course of the disease, affecting predominantly the lungs, but also the liver, spleen and skeleton. [...]