Cancers of the bladder are the ninth most common malignant cancers worldwide, affecting nearly 430,000 people annually. In India, about 18,921 cases of bladder cancer were reported in 2021. Surgery is an integral treatment for most bladder cancers. The type of surgery will depend on the stage or extent of the cancer. It also depends on your surgeon’s expertise based on individual’s health.
The following are the types of surgeries performed to treat bladder tumours.
Transurethral Resection of Bladder Tumour (TURBT)
- Transurethral Resection of Bladder Tumour (TURBT) or Transurethral Resection (TUR) is performed to find out if you have bladder cancer.
- It is the most common treatment for early-stage or superficial (non-muscle invasive) bladder cancers.
- Most patients have peripheral cancer when they are diagnosed, and this is usually their first treatment. Sometimes, a secondary and more extensive TURBT is performed to ensure that all cancerous tissue has been removed.
- The surgery aims to take out the cancer cells and nearby tissues down to the muscle layer of the bladder wall.
- This surgery is performed by using an instrument inserted through your urethra under general or regional anaesthesia
- A thin, rigid instrument called a “Resectoscope” is put into your bladder through your urethra.
- It has a wire loop at the end and this loop is used to remove any abnormal tissues or tumours and sent to a lab for testing.
- The tissues in the area where the tumour was may be burned off through a process called “Fulguration”.
- Cancer cells can also be destroyed using a high-energy laser inserted through the resectoscope.
- When bladder cancer has become invasive, the bladder may need to be removed as a whole or in parts
- This surgery is called a “Cystectomy” and chemotherapy is given before cystectomy is done.
- General anaesthesia is used for this type of surgery
- If cancer has invaded the muscular layer of the bladder wall but is not very big in size and localised, it can be removed by a partial cystectomy
- This is done along with part of the bladder wall without removing the whole bladder.
- The lymph nodes in proximity are also removed and tested for the extent of spread
- The main advantage of this surgery is that the person keeps their bladder and doesn’t need reconstructive surgery.
- If the cancer is larger or is in more than one part of the bladder, a radical cystectomy will be needed.
- This operation removes the entire bladder and nearby lymph nodes along with the prostate and seminal vesicles in men.
- In women, the ovaries, fallopian tubes, the uterus, cervix, and a small part of the vagina are removed
- Most of the time, cystectomy is done through an incision in the abdomen and some cases, the surgeon may operate through many smaller incisions as in a laparoscopic surgery
- This procedure is known as laparoscopy and uses instruments, one of which has a tiny video camera at the end to visualize the internal structures
- The surgeon may sometimes use robotic arms to do the surgery known as a robotic cystectomy. This type of surgery results in less pain and a speedier recovery
Reconstructive Surgery after Radical Cystectomy
If your whole bladder is removed, a way to store urine and pass it out of your body has to be created and for this purpose, several types of reconstructive surgery can be performed
a. Incontinent diversion
- A short piece of your intestine is connected to the ureters creating a passageway, known as an “Ileal Conduit”
- The urine passes from the kidneys through the ureters into the ileal conduit. One end of the conduit is connected to the skin on the front of the abdomen by an opening called a stoma
- A small bag is attached to the skin of your abdomen around the stoma to collect the urine. The bag must be on all the time and must be emptied whenever it’s full. This is called an incontinent diversion because you have no control over the flow of urine
b. Continent diversion
- Another way for the urine to drain is a technique known as continent diversion.
- A pouch is created from a piece of the intestine and attached to the ureter.
- One end of the pouch is connected to the stoma in your skin on the front of your belly.
- A one-way valve is created that allows urine to be stored in the pouch.
- You can empty it several times a day by putting a catheter into the stoma through the valve.
- The surgeon creates a new bladder (neobladder) from a piece of the intestine.
- Similar to the incontinent and continent diversions, the ureters are connected to the new bladder created.
- This technique lets you urinate but on a schedule and over time, most patients regain the ability to urinate normally during the day
- If cancer has spread or cannot be removed with surgery, a diversion may be made without removing the bladder. In this case, the purpose of the surgery is to prevent or relieve a blockage of urine flow, rather than try to cure cancer.