Bladder Cancer Treatment Options

Bladder Cancer Surgery

While chemotherapy, immunotherapy and radiation always remain options for treating bladder cancer, surgery is the gold standard in eradicating this disease. Skilled surgeons use a wide range of techniques that range from removing tumors through the urethra to removing part or all of the bladder. Since most bladder cancers are diagnosed at the superficial, or non-invasive, stages, surgery is an effective treatment option.

Surgical Options

There are three main surgical options for bladder cancer removal. The type and scope of the surgery will largely depend on the disease advancement.

  • Transurethral resection (TUR): A doctor passes a thin, tube-like instrument called a cystoscope through your urethra into your bladder. No incision is required. A small wire loop at the end of the tool burns and removes cancerous cells and tumors.
  • Partial cystectomy: A partial cystectomy removes only the cancerous tissues from the urinary bladder. This allows you to keep your bladder and does not require reconstructive surgery.
  • Radical cystectomy: Surgeons remove the entire diseased bladder and surrounding lymph nodes. In men, the prostate and the seminal vesicles are also removed. In women, the ovaries, fallopian tubes, uterus and part of the vagina are also removed. In some cases, surgeons use less-invasive laparoscopic surgical techniques, which is less painful and quicker.

Surgical Urinary Tract Reconstruction

Years ago, bladder cancer patients had only one option once the bladder was removed – an external urine collection bag. Today, skilled surgeons can create new urine collection reservoirs from the patient's small intestines. There are several urinary diversions used.

  • Ileal conduit: This is the oldest and simplest of urinary diversion. Ducts from the kidneys drain into the ileum, or last segment of the small intestines, and then drain out of the body through an opening in the abdominal wall called a stoma. Urine is collected in an external bag.
  • Indiana pouch reservoir: For this, a pouch is created out of a portion of the small and large intestines. Every few hours, the patient passes a thin tube into the pouch through a stoma and empties the urine.
  • Neobladder to urethra diversion: This procedure closely mimics the original urinary bladder. A small pouch is made from the small intestine and is connected to the urethra. The patient is able to pass urine similar to before surgery.

Surgical Side Effects and Complications

Depending on what procedure you had, the recovery time from bladder cancer surgery can range from a couple of days to weeks. The less invasive procedure, the TUR, requires little downtime because there are no surgical incisions. This procedure is usually done at an outpatient facility. Even though bladder cancer is known to reoccur, a TUR can be repeated several times with success.

The more invasive cystectomy and reconstruction surgeries require hospital stays and recovery periods. The typical four to six week recovery could include excessive bleeding, incontinence and urine flow blockage. Both men and women could suffer sexual side effects from the radical cystectomy. For men, removal of the seminal vesicle means semen will not be produced. For women, the surgical removal of part of the vagina could make sex uncomfortable.

Because bladder cancer is often caught in the early stages, the survival rate is very good. With early discovery, the overall five-year survival rate for bladder cancer is 80 percent.

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