Keywords:
bladder cancer
chronic kidney disease
hypertension
radical cystectomy
opioid-sparing anesthesia
thoracic epidural analgesia

  • Abstract

    Radical cystectomy with ileal conduit urinary diversion is a complex and extensive surgical procedure, most often performed in patients diagnosed with advanced bladder cancer. Optimal anesthetic and perioperative management are critical for ensuring favorable outcomes, particularly in patients with coexisting comorbidities. This report discusses the case of a 52-year-old male patient with advanced bladder cancer, hypertension, and chronic kidney disease who underwent radical cystectomy with ileal conduit diversion. The patient’s pre-existing hypertension and renal dysfunction necessitated a tailored anesthetic approach aimed at optimizing cardiovascular stability, minimizing nephrotoxic insults, and maintaining an appropriate fluid balance. General anesthesia combined with thoracic epidural analgesia was chosen to provide effective pain control and hemodynamic stability. Invasive monitoring techniques, including arterial blood pressure and central venous pressure monitoring, were employed to guide fluid resuscitation and ensure adequate renal perfusion. Opioid use was judiciously restricted to avoid renal compromise, and multimodal analgesia was utilized to manage postoperative pain effectively. Postoperative care emphasized close monitoring of renal function, prevention of complications, and early mobilization. Targeted antibiotic therapy was initiated to manage a urinary tract infection detected intraoperatively, while preventive measures such as prophylactic anticoagulation and incentive spirometry were implemented to minimize risks of deep vein thrombosis and pulmonary atelectasis. The patient’s postoperative course was notable for stable renal function, effective pain control, and an uneventful recovery. This case underscores the critical role of individualized anesthetic management in high-risk patients undergoing radical cystectomy. A holistic approach encompassing presurgical optimization, meticulous intraoperative monitoring, and vigilant postoperative care is essential to improve outcomes and mitigate potential complications in patients with renal dysfunction and hypertension undergoing major urologic surgery.

  • References

    1. Aminoltejari, K., & Black, P. C. (2020). Radical cystectomy: A review of techniques, developments and controversies. Translational Andrology and Urology, 9(6), 3073–3081. https://doi.org/10.21037/tau.2020.03.23
    2. Benyamin, R., Trescot, A. M., Datta, S., Buenaventura, R., Adlaka, R., Sehgal, N., Glaser, S. E., & Vallejo, R. (2008). Opioid complications and side effects. Pain Physician, 11(2), S105–S120.
    3. Chekol, W. B., Melesse, D. Y., Denu, Z. A., & Tawuye, H. Y. (2020). Evidence-based thoracic epidural nerve block: A systematic review. International Journal of Surgery Open, 24, 151–155. https://doi.org/10.1016/j.ijso.2020.05.004
    4. De Backer, D., & Vincent, J.-L. (2018). Should we measure the central venous pressure to guide fluid management? Ten answers to 10 questions. Critical Care, 22(1), 43. https://doi.org/10.1186/s13054-018-1959-3
    5. Freise, H., & Van Aken, H. K. (2011). Risks and benefits of thoracic epidural anaesthesia. British Journal of Anaesthesia, 107(6), 859–868. https://doi.org/10.1093/bja/aer339
    6. Igel, D. A., Chestnut, C. J., & Lee, E. K. (2021). Urinary diversion and reconstruction following radical cystectomy for bladder cancer: A narrative review. AME Medical Journal, 6, 4. https://doi.org/10.21037/amj-20-76
    7. Lee, R. K., Abol‐Enein, H., Artibani, W., Bochner, B., Dalbagni, G., Daneshmand, S., Fradet, Y., Hautmann, R. E., Lee, C. T., Lerner, S. P., Pycha, A., Sievert, K., Stenzl, A., Thalmann, G., & Shariat, S. F. (2014). Urinary diversion after radical cystectomy for bladder cancer: Options, patient selection, and outcomes. BJU International, 113(1), 11–23. https://doi.org/10.1111/bju.12121
    8. Pasquina, P., Tramér, M. R., Granier, J.-M., & Walder, B. (2006). Respiratory physiotherapy to prevent pulmonary complications after abdominal surgery. Chest, 130(6), 1887–1899. https://doi.org/10.1378/chest.130.6.1887
    9. Renner, J., Grünewald, M., & Bein, B. (2016). Monitoring high-risk patients: Minimally invasive and non-invasive possibilities. Best Practice & Research Clinical Anaesthesiology, 30(2), 201–216. https://doi.org/10.1016/j.bpa.2016.04.006
    10. Roy, P. J., Weltman, M., Dember, L. M., Liebschutz, J., & Jhamb, M. (2020). Pain management in patients with chronic kidney disease and end-stage kidney disease. Current Opinion in Nephrology & Hypertension, 29(6), 671–680. https://doi.org/10.1097/MNH.0000000000000646
    11. Zee, A. A., Van Lieshout, K., Van Der Heide, M., Janssen, L., & Janzing, H. M. (2017). Low molecular weight heparin for prevention of venous thromboembolism in patients with lower-limb immobilization. Cochrane Database of Systematic Reviews, 2017(8), CD006681. https://doi.org/10.1002/14651858.CD006681.pub4
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How to cite

Gohad, R., Jain, S., & Paul, A. (2025). Anesthetic management and perioperative care in a high-risk patient with bladder cancer, hypertension, and chronic kidney disease undergoing radical cystectomy with ileal conduit urinary diversion: A case report. Multidisciplinary Science Journal, 7(8), 2025408. https://doi.org/10.31893/multiscience.2025408
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