Bladder cancer surgery

Oncologic surgery for bladder cancer is the indicated treatment for removing tumors and the area around it. It is one of the most used procedures against this type of cancer, along with chemotherapy and radiotherapy. Know more.
Bladder cancer surgery

Most bladder cancers benefit from surgery to remove the tumor and some of the healthy tissue around it as the main treatment. The choice of your type will depend on factors such as the stage of the disease, the location of the tumor and the patient’s health status.

Types of surgery for bladder cancer

The main surgical approaches to bladder cancer currently available are:

  • Transurethral resection (TURb) – used in various functions, such as for the diagnosis, staging and treatment of bladder cancer. During bTUR, the surgeon inserts a device called a cystoscope through the urethra; it goes to the bladder and makes it possible to visualize the region for removal of the tumor and adjacent tissues. This procedure is usually sufficient for patients with non-invasive bladder cancer. However, the doctor may combine approaches such as chemotherapy or immunotherapy to prevent the cancer from coming back. Patients with invasive bladder cancer may need to have their bladder completely removed or undergo chemotherapy and/or radiation therapy;
  • Radical cystectomy and lymph node dissection – This involves the complete removal of the bladder and possibly the tissues and organs adjacent to it. In men, the prostate and part of the urethra are usually removed; in women, the uterus, fallopian tubes, ovaries and part of the vagina – this procedure is called pelvic lymph node dissection and is the safest way to locate cancer that has spread to the lymph nodes. Radical cystectomy can be performed less invasively by videolaparoscopy or robotic surgery;
  • Partial cystectomy – removes only a portion of the bladder. It is the best option when the cancer is located in the wall of the organ and in only one area that can be removed easily and without harming the functioning of the bladder;
  • Urinary diversion – if the bladder is completely removed, the doctor will create a new path for the urine to be eliminated from the body. One way to do this is to use a small portion of the small intestine or colon to divert urine to a stoma or ostomy (an opening) on ​​the outside of the body. The patient must use a bag attached to the stoma to collect and drain urine. In certain cases, it is possible to make a urine reservoir that is not exposed, located inside the body, using a part of the large or small intestine and avoiding the use of the external collection bag. This procedure creates a “new” bladder, allowing the patient to eliminate urine in a more natural way; and
  • Robotic Surgery in Bladder Cancer – Robotic surgery is becoming the preferred technique choice in bladder cancer. This surgical procedure allows the surgeon to make smaller incisions that spare nerve and muscle tissue. The patient, in turn, has a shorter hospital stay, with a lower risk of infections, complications and a faster recovery time. In this surgery, a robotic arm mimics the surgeon’s movements, increasing their precision. It offers bladder cancer patients the prospect of more effective, safer surgery and post-surgical recovery with less risk of complications.

Studies comparing the robot-assisted procedure with the traditional technique (‘open’ surgery, performed with a larger incision in the abdomen) have shown that robotics offers equivalent oncological and perioperative results, with the advantage of less bleeding and less need for blood transfusion.

Possible complications and adverse effects of the surgery

Living with bladder cancer can affect the patient’s quality of life. Therefore, the main objective of treatment is to try to keep the bladder fully intact or, at least, part of it.

The main adverse effects of surgery for bladder cancer depend on the procedure adopted. In general, there may be:

  • Delay in the recovery period;
  • Infection;
  • Clots or bleeding;
  • Discomfort after surgery and damage to organs near the bladder;
  • Urinary infection or urinary leakage after cystectomy or urinary diversion;
  • After cystectomy, the man may face erectile dysfunction;
  • Nerve damage to the pelvis and loss of sexual sensitivity and orgasm (in both men and women) – however, there are treatments that can be done in the postoperative period to circumvent this problem; and
  • Temporary loss of stamina or physical strength.
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