Bladder cancer in the early and later stages of the treatment involves carrying out various types of operations.
Assuta Hospital is one of the largest private medical centers in Israel, the main thrust of which - surgical treatment. The hospital has the most modern technologies and attracting the best doctors.
Our company - the medical service «Unims» - official representative of Assuta. We offer the provision of treatment as soon as possible at highly skilled experts in the most comfortable conditions.
Let us consider what surgical procedures are carried out at different stages of the disease.
Surgery for bladder cancer - superficial forms
Surgery is the basic method of treatment of non-invasive bladder cancer. Typically, one or several small tumors on body mucosal surgically removed via a cystoscope.
Before the surgery for bladder cancer
Surgeon-urologist explains what action the patient tells what to expect immediately after surgery, and a few days later. This is a good opportunity for the patient to ask his questions.
The day before the surgery the patient will be hospitalized so doctors could carry out the necessary diagnostic. The medical examination will include a blood test to check your overall health. It is necessary to find out in what shape is sick, if he undergo surgery and general anesthesia. It is also possible to conduct diagnostic day hospital.
During surgery the surgeon inserts a cystoscope into the bladder and removes the tumor with the help of tools, which are transmitted through it. mild electric current to stop bleeding may be used (moxibustion).
This operation for bladder cancer is called transurethral resection (TUR) . The term transurethral surgery holding means through the urethra (urethra) connected to the bladder.
After surgery for bladder cancer - transuretaralnoy resection
Patients will be encouraged to get out of bed and walk as soon as he feels well enough. This is important to prevent complications such as infection or blood clots. Most patients given a single dose of cytostatic agents directly into the bladder immediately after surgery.
Patient is fitted with a catheter in the bladder. The first time may experience blood in the urine. In this period it is recommended to drink plenty of fluids, which will help wash out the bladder and reduce the likelihood of infection.
Sometimes use a continuous bladder irrigation, connecting the catheter to the irrigation system and washing the body. Due to the fact that urine contains blood which can trigger thrombus.
When the urine is clear, the catheter will draw, it will be possible to leave the hospital - about 2-3 days after surgery for bladder cancer.
Potential risks and complications
Operation TUR, is generally safe procedure. However, as with any surgery there are risks.
Urinary Tract Infections
Some people develop an infection during a hospital stay or after they leave it. Signs of infection include: fever, malaise, clouding of urine or change in its smell.
Bleeding that lasts for several days
Approximately three hundred people from a blood transfusion is required. If bleeding continues, it may require another operation to stop it. In some patients, bleeding can last for 10-14 days after TUR.
Damage to the bladder
There is a small risk of organ damage during surgery - a perforation (hole). If this occurs, the bladder catheter is placed for 7-10 days until the opening is not delayed. If it does not heal, surgery is performed.
When is the probability that cancer cells may remain, doctors, a few days after surgery perform another TUR.
Cystectomy - surgery to remove the bladder
It is very rarely necessary. To her resorted once been tried other treatments, but the disease returned.
Cystectomy task - to eliminate the cancer before it has spread in the muscular layer and possibly to other body parts and organs (secondary or metastatic cancer). When there are lesions in other organs, can not cure the disease.
The decision to remove the bladder in the treatment of non-invasive cancer is very difficult to accept. The urologist will weigh the possible benefits and risks, offering cystectomy.
Surgery for bladder cancer - invasive form
In most cystectomy (removal of the bladder) is held in data forms of the disease. It may be recommended chemotherapy to reduce tumor size.
The doctor will explain which type of surgery is most appropriate for each individual case. Cystectomy can be performed on the phases II and III disease.
In some cases, it is possible to perform a partial cystectomy, when removing only part of the body. After this surgery, a person can urinate the usual, traditional way. Despite this, the body is reduced and is able to accommodate a smaller amount of urine, so the process of urination is more frequent.
Removal of the bladder (cystectomy)
During this operation is completely removed from the body bladder. Men also resected prostate, urethra and surrounding lymph nodes. The women - the bladder, uterus, ovaries, cervix, urethra, vagina, and located next to the lymph nodes.
After cystectomy the man is no longer able to get and maintain an erection. Women change sexual feelings, or is no longer possible sexual intercourse.
In some cases a removal of part or all of body using minimally invasive surgery. The surgeon performs small incisions instead of one cavity (3 and 1 small size little larger). It uses a laparoscope to see and work inside the abdomen. A laparoscope is placed into the abdomen through a small incision.
Assuta Hospital offers the possibility of robotic surgery for bladder cancer - a more refined and advanced technology.
Execution of such operations requires special training and experience. The surgeon discusses with the patient the advantages and risks of this approach.
Restoration of bladder
After removal of the organ used alternative techniques to store and withdraw urine from the body. There are different ways. The surgeon will talk about the most suitable for the patient and will provide more detailed information. Similar operations in bladder cancer are performed by specially trained surgeons.
This surgery is performed more often. The surgeon removes the part of the small intestine, it connects the two ureters one side and the other outputs to the skin surface through the small opening (stoma).
The ureters carry urine from the kidneys to the part of the intestine. This segment of the small intestine (ileum) acts as a conduit (pipe), to withdraw urine from the body to the surface. For this reason, the operation is sometimes called ileal conduit (ileal conduit). The small hole on the skin surface is called the stoma.
To fasten stoma waterproof bag for collecting urine. His need to be emptied regularly.
Kontinentnoe urinary diversion (inner bag)
With this type of operation there is no need for an external pouch to collect the urine. The surgeon uses a part of the intestine to create intra-abdominal bag for urine storage. To it are attached ureters leading out urine from the kidneys.
As urine will come out from the body depends on the type of operation selected. The bag may be connected to the stoma. An alternative is to connect to the urethra.
The reservoir with the output on the abdominal wall
This type of operation, when the inner bag, bladder replacement, is connected to the stoma in the abdominal wall. Used to drain urine catheter catheterization person spends about five times a day. Despite the fact that initially it is very concerned about, most patients quickly get used to the procedure and stoma care.
During this surgery the surgeon connects the new bladder to the urethra. This means that people will be able to urinate in the same way as before. However, in order to empty the pouch will stretch the abdominal muscles is necessary. Also, the process will need to perform on a regular basis, because they were lost the nerves that signal the body of the bladder is full. You may need to self-catheterization to empty the bladder fully. This process train nurse.
There is a small risk of recurrence of cancer in the urethra. Therefore need to be further diagnosis, this time is explained in detail to the patient.
Sometimes it is possible to withdraw the urine into the rectum, bringing her through the anus along with stool. If this is done, people will not need an external bag to collect urine or catheterization for its removal.
After surgery for bladder cancer - cystectomy and restore bladder
After surgery, the patient will be in the intensive care unit. Nurses will encourage him to begin to move as soon as possible. It is an integral part of the recovery, as it helps to prevent unwanted effects - infections and blood clots. If the patient has to stay in bed, will need regular leg movements and deep breathing exercises. A physical therapist will help.
For a short time it can be attached to the patient the following devices:
- Dropper, through which the body fluid will flow until the patient is able to make their own food and drinks, as well as through them administered painkillers.
- Drains in the wound area to prevent swelling and to ensure proper healing.
- A nasogastric tube which is inserted through the nose into the stomach or small intestine, and allows removal of liquid (approximately 48 hours).
- The thin tube in the back (epidural) through which received analgesics affecting nerves and stopping pain.
After surgery for bladder cancer patient for a few days will give painkillers - intravenously, epidurally, intramuscularly, or in the form of tablets.
Initially, it may receive analgesics through a syringe connected to the electric pump (electric pump). It is mounted to the body receives a constant dosage of anesthetic. Also, the patient himself can manage it with the button that can be pressed, when he is in pain. This so-called patient controlled analgesia. It is designed in such a way that an overdose can not be.
Some patients pose an epidural to numb the nerves.
Duration of hospital stay due to the type of operation - 7-14 days. The doctor will give advice when you can get back to work, driving, various occupations, including in sports. Before the patient leaves the hospital, he will give direction to outpatient care for the survey, which will be held a few weeks after surgery for bladder cancer, this is a good time to discuss any concerns with your doctor.