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Surgical Procedures for Bladder Cancer

Surgery is the initial procedure in the treatment of many solid cancers. Surgery and other invasive procedures work by removing cancerous tissues.
There are four types of surgical procedures available to treat bladder cancer:
  • Transurethral bladder tumor resection—The tumor is removed through a flexible, tubelike instrument called a cystoscope that is inserted into the bladder through the urethra.
  • Partial cystectomy —The tumor and only part of the bladder are removed through an open abdominal incision.
  • Total cystectomy—The tumor and the entire bladder are removed.
  • Radical cystectomy—The tumor, the entire bladder, and surrounding lymph nodes and neighboring organs are removed.
You and your doctor will discuss which procedure is appropriate for you, based on your health, your tumor grade and stage, how many tumors are present in the bladder, and other factors.

Transurethral Bladder Tumor Resection

This type of bladder surgery can usually be used to treat very early forms of bladder cancer. Instead of using an open abdominal incision, all of the instruments are passed through the urethra and into the bladder. A cystoscope is used to view the inside of the bladder and locate the tumor. The tumor may be removed through a burning process called fulguration, laser, cutting, or by the application of destructive chemicals.
Description of the Procedure
You and your doctor will discuss whether you will need general anesthesia for this surgery or whether you can receive regional anesthesia such as a spinal anesthetic that only numbs your body from the waist down.
Your surgeon will fill your bladder with fluid. Then, the cystoscope is inserted through the urethra and into the bladder. The surgeon uses this instrument to view the inside of the bladder and to remove the tumor. After this is done, a urinary catheter tube will be used to drain urine into a bag. It will be left in your urethra and bladder. Your urine may look bloody for days or even weeks.
After a transurethral bladder tumor resection, you may go home that day or stay in the hospital for several days. This may depend on your baseline level of health and the outcome of the procedure.
Effectiveness
Transurethral bladder tumor resection can cure cancer in patients with very superficial, early stage bladder cancer. For patients with higher tumor grades, or more invasive types of cancer, other types of treatment such as chemotherapy, radiation , or more extensive surgery may be needed in addition to transurethral bladder tumor resection.
Possible Complications
The following complications may occur with this procedure:
  • Bleeding
  • Infection
  • Difficulty or pain with urination after your surgery
  • Leaking urine after surgery
  • More frequent need to urinate—This may occur because your bladder has a smaller capacity after surgery
  • Bladder or urethra may be damaged, scarred, or become more narrow after surgery, requiring a corrective procedure
  • Surgery may not be able to remove all of the cancer cells that are present, meaning that you will require additional treatment for your tumor
Postoperative Care
You will need several weeks to recover from a transurethral bladder tumor resection and begin to feel well again. You’ll probably be sent home with a urinary catheter in your bladder. You’ll be asked to drink plenty of water to flush pieces of the tumor out with the urine. You will notice bloody urine, although this should decrease as you begin to recover. If bleeding increases, it may be because you have too rapidly accelerated your activity level; lie down and rest. If the bleeding continues, call your doctor.
After the urinary catheter is removed, you may have trouble controlling your bladder for a period of time.
While you are recovering, get plenty of sleep, don’t lift anything heavier than 10 pounds, and consult your doctor about when you can begin to participate in your usual activities, including driving.

Cystectomy

This surgery uses an open abdominal incision to expose the bladder and remove the tumor. Depending on the tumor’s grade, whether it has invaded the muscle, and the size of the tumor, part (partial cystectomy) or all (total cystectomy) of the bladder may be removed. The procedure is called a radical cystectomy if other nearby organs and tissue are also removed, such as lymph nodes, urethra, prostate, uterus, fallopian tubes, and/or ovaries.
If your entire bladder must be removed, the surgeon may try to create a new bladder out of a piece of your intestine, or may create an opening in your abdomen called a stoma to allow your urine to pass into a bag that you will need to wear.
Description of the Procedure
You’ll be given general anesthesia for this procedure. You’ll also be given medicines and fluids through an IV. A tube will be put down your throat to allow a machine to breathe for you while you are anesthetized. A tube placed through your nose and into your stomach will drain any digestive juices that build up during the surgery. It may be left in place after surgery.
An incision will be made across the lower part of your abdomen. Depending on the situation, either just the tumor and part of your bladder will be removed, or your entire bladder and other neighboring organs will be removed. This may include reproductive organs in women.
If your entire bladder is removed, part of the time you spend in surgery will be used to help create a new reservoir for your urine. It will use a piece of your intestine. Or, it will send the urine out of your body through a new opening created in your abdomen called a stoma and into a bag that you will wear externally.
Depending on the extent of the surgery, your baseline level of health prior to surgery, and how speedily you recover from your surgery, you’ll probably stay in the hospital for 2-7 days.
Effectiveness
Cystectomy may provide a cure for some types of bladder cancer. Other types of bladder cancer will require additional treatments, such as radiation. Cystectomy is used when the cancer has invaded the bladder wall. Additional treatment is required when examination of the tissue removed at surgery indicates that the tumor has spread into the surrounding pelvis.
Possible Complications
After a cystectomy, there is a risk for certain complications, including the following:
  • Bleeding
  • Infection
  • Numbness, pain, or lack of nerve function, which may occur if nerves in the pelvis are cut during surgery
  • The ureters or the area of intestine used to create your urine reservoir may not be completely sealed, allowing urine to leak into your abdomen.
  • If you have a partial cystectomy, you may have trouble urinating, you may leak urine for a time after surgery, or you may notice that your bladder has a smaller capacity, requiring you to urinate more frequently.
  • Men may be impotent after cystectomy, although newer nerve-sparing techniques may prevent this complication.
  • Women who have radical cystectomies will be infertile after their reproductive organs are removed.
  • Surgery may not be able to remove all of the cancer cells that are present.
Postoperative Care
As with any major surgery, you will need 6-8 weeks for recovery. During this time, get plenty of sleep, don’t lift anything over 10 pounds, and consult with your surgeon about when you can begin to participate in your usual activities, including driving.
In addition, you'll receive the following care after your surgery:
  • You’ll need continued fluids and nutrition through an IV until your intestines are functioning normally again.
  • You may need to have a tube left in your nose to drain the digestive fluids from your stomach until your intestines are back to normal.
  • You may need to have drains left in place for several days or more. These drains are tubes that drain excess fluid that builds up in your abdomen after surgery.
  • If you had only part of your bladder removed, you may need to have a urinary catheter left in place for some time. A urinary catheter is a tube to drain urine that is inserted through your urethra and into your bladder.
  • If you had your entire bladder removed, you may need to have your urine collect in a bag, either temporarily or permanently.
  • or you may have a urinary catheter left in your bladder while you are recovering from surgery without bladder removal.
  • If you will be wearing a urine-collection bag either temporarily or permanently, you’ll need to learn how to change the bag.
  • If you have had surgery to remove your bladder due to bladder cancer, you will need help learning how to care for the new opening created to allow urine to drain out of your body. This stoma must be carefully cared for to avoid getting an infection and to prevent irritation to the stoma and surrounding skin. There are specially trained nurses and therapists who can help you learn to care for the stoma and change the collection bags.

References

Bladder cancer. American Cancer Society website. Available at: http://www.cancer.org/cancer/bladdercancer/. Accessed June 5, 2013.

Bladder cancer. Urology Care Foundation website. Available at: http://www.urologyhealth.org/urology/index.cfm?article=100. Updated March 2013. Accessed June 5, 2013.

What you need to know about bladder cancer. National Cancer Institute website. Available at http://www.cancer.gov/cancerinfo/wyntk/bladder . Updated August 30, 2010. Accessed June 5, 2013.

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