Bladder Cancer Surgery
Most bladder cancers benefit from surgery to remove the tumor and part of the surrounding healthy tissue as the primary treatment. The choice of surgery depends 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 available today are:
- Transurethral resection (TURBT) – used for various purposes, such as diagnosis, staging, and treatment of bladder cancer. During TURBT, the surgeon inserts a cystoscope through the urethra; it goes into the bladder and allows visualization of the area 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 cancer recurrence. Patients with invasive bladder cancer may need to have the bladder completely removed or undergo chemotherapy and/or radiation therapy;
- Radical cystectomy and lymph node dissection – 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 in a less invasive way by laparoscopy or robotic surgery;
- Partial cystectomy – removes only a portion of the bladder. It is the best option when cancer is located in the wall of the organ and in only one area that can be easily removed without affecting the bladder’s function;
- Urinary diversion – if the bladder is completely removed, the doctor will create a new pathway for urine to be eliminated from the body. One way to do this is by using 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 will need to use a bag attached to the stoma to collect and drain urine. In certain cases, it is possible to create a reservoir for urine that is not exposed, located inside the body, using a part of the large or small intestine and avoiding the use of an external collecting 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 rapidly growing in bladder cancer. This surgical procedure allows the surgeon to make smaller incisions, sparing 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, enhancing their precision. It offers bladder cancer patients the prospect of a more effective, safer surgery, and a post-surgical recovery with a lower risk of complications.
Studies comparing robot-assisted procedures with traditional techniques (open surgery, performed with a larger incision in the abdomen) have shown that robotics offer equivalent oncological and perioperative outcomes, with the advantage of less bleeding and a lower need for blood transfusion.
Possible complications and adverse effects of bladder cancer surgery
Living with bladder cancer can affect the patient’s quality of life. Therefore, the main goal of treatment for bladder cancer 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, the following may occur:
- Extended 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, men may face erectile dysfunction;
- Pelvic nerve injury and loss of sexual sensitivity and orgasm (in men and women) – however, there are treatments that can be done in the postoperative period to overcome this problem; and
- Temporary loss of endurance or physical strength.
Treatments for Bladder Cancer
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