Bladder Cancer Treatments
Patients diagnosed with certain types of bladder cancers may be suitable for bladder washouts using chemotherapeutic agents to try to reduce the risk of recurrence of further tumours. Recurrence of bladder tumours is common. Frequent cystoscopies to identify and destroy recurrent tumours are therefore required to reduce the risk of the cancers progressing to more aggressive tumours. If recurrent tumours become a problem, bladder washouts (intravesical therapy) usually involve 6 treatments over a 6 week period (1/week, each lasting 1-2 hours). A catheter is placed in the bladder and the agent introduced and left in the bladder for 1 to 2 hours. There are different agents available and the particular agent will depend on the type of tumour that you have. These treatments are usually tolerated very well. Patients sometimes experience bladder discomfort with frequency and urgency and occasionally bleeding. If patients are particularly uncomfortable the treatment program can be deferred for a week to allow the bladder to settle down. A cystoscopy will be required about 8 weeks after the treatment. Maintenance treatments are often arranged periodically to keep the cancers under control. If tumours continue to recur, more aggressive treatment may be indicated.
If your bladder tumour has been found to invade into the muscle wall of the bladder the standard treatment is to remove the bladder completely and to divert the urine. The usual form of diversion is called an ileal conduit. A 15cm to 20cm segment of small bowel is isolated and separated from the rest of the small intestine. The ureters that drain urine from the kidney are plugged into one end of the isolated segment with the other end being sutured to the skin of the abdominal wall allowing the urine to drain into a bag that is attached around the opening on the skin. This is major surgery and will require the patient to be in Hospital for 7 to 10 days. If the tumour was completely confined to the bladder the cure rates are very high. Usually, additional therapy is not required.
Cystectomy is now being performed by Robotic minimally invasive techniques. This greatly limits the morbidity of open surgey and reduces the hospital stay.
An alternative to an ileal conduit is to have a Neobladder (new bladder) created out of small bowel. This negates the need for a bag attached to the skin of the abdomen and in many cases the neobladder functions virtually as a normal bladder. In this procedure the bladder is removed as for a normal cystectomy. A longer segment of small bowel is isolated and can be used to create a functional bladder. The ureters are sutured into the top of the neobladder that will then store urine as a normal bladder does. The patient then learns to void and in most cases will function quite normally. Patients undergoing formation of a neobladder need to be motivated and dextrous. Patients will need to learn to catheterise themselves which may be required in certain circumstances if mucous formed by the bowel restricts the flow of urine. Intermittent self catheterisation may also be required to help empty the bladder if it does not empty adequately. Most patients are suitable for neobladders but this requires detailed discussion with your Urologist to be able to give you all the relevant information required to manage your new bladder.