Bladder cancer surgery
In this section, we introduce the surgical approaches to bladder cancer:
Removal of a bladder tumor through the urethra
In the TURBT method, the surgeon removes cancerous tumors of the bladder, which are confined to the inner mucosal layers of the bladder and have not yet involved the muscles, through the urethra. The surgeon passes a small wire loop through the cystoscope and inserts it into the bladder. An electric current is then applied to the wire to burn all the cancer cells. Of course, instead of wire, a high-power laser can be used to destroy cancer cells. TURBT is performed under local anesthesia (general anesthesia) or general anesthesia. Because the operation is performed through the urethra, no incisions are made in the abdomen.
Doctors sometimes suggest that a single injection of chemotherapy drug be injected into the body, kills the remaining cancer cells, and prevents cancer from coming back. The drug stays in the bladder for about an hour and then drains.
Cystectomy is performed to remove all or part of the bladder. In a partial cystectomy, the surgeon removes only the part of the bladder that contains a single cancerous tumor. A partial cystectomy is only possible when the cancer is confined to one part of the bladder and the tumor can be removed without damaging bladder function. In a radical cystectomy, the entire bladder, part of the ureter, and adjacent lymph nodes are removed. Radical cystectomy in men is usually associated with the removal of the prostate and seminal vesicles. If the patient is a woman, the uterus, ovaries, and part of the vagina are also removed during a radical cystectomy. Radical cystectomy can be performed by making an incision in the lower abdomen or by making several small incisions by robotic surgery. In robotic surgery, the surgeon sits close to the console and moves the robotic surgical instruments with extreme precision. Complications of cystectomy include infection and bleeding. Removal of the prostate and seminal vesicles in men can also lead to erectile dysfunction. Of course, the surgeon can maintain the nerves necessary for an erection. Female ovarian resection also leads to infertility and premature menopause.
New bladder reconstruction
After a radical cystectomy, the surgeon creates a new way for urine to leave the body. New bladder reconstruction is a way to direct urine flow out of the body. The surgeon creates a spherical reservoir using a piece of the intestine. This reservoir often referred to as the new bladder, is inserted into the body and connected to the urethra. In most cases, the new bladder allows the patient to urinate normally. A small number of patients with a new bladder have difficulty emptying the new bladder and are forced to urinate from the new bladder from time to time.