When a patient is diagnosed with bladder cancer, removing the tumor is one of the first options considered. The type of surgery will depend on the stage and grade of the cancer. There are two surgical options:
- Transurethral Resection of Bladder Tumor (TURBT): This procedure may be suggested for slow-growing cancers that remain confined to the bladder lining. A surgeon uses a cystoscope with a loop cutting tool inserted into the bladder through the urethra, to remove the tumor. If necessary, an electric current may be used to burn away remaining cancer cells (referred to as fulguration). The doctor may also take biopsies of both the tumor and surrounding normal cells.
- Cystectomy: Partial or total (radical) removal of the bladder may be the best option for aggressive cancers. A radical cystectomy removes the entire bladder, nearby lymph nodes, part of the urethra and nearby organs that may contain cancer cells. In men, the prostate gland is usually removed and sometimes the urethra. In women, the lower end of the ureters, the front wall of the vagina, the uterus, fallopian tubes and ovaries are usually removed. In some instances, a segmental (or partial) cystectomy is performed where only the cancer and some of the bladder tissue around the tumor are removed.
Since 2005, Roswell Park has offered a minimally invasive option for surgical bladder removal called robot-assisted radical cystectomy. Today, more than 98 percent of all bladder cancer surgeries are performed with robotic assistance. While open surgery involves a long incision, robotic surgery is done laparoscopically — through small incisions in the abdomen. The technology used is Intuitive Surgical’s da Vinci® Surgical System, which offers breakthrough surgical capabilities, imitating the movements of a human surgeon’s hands while increasing precision.
Patients who have robotic-assisted cystectomy experience 50 percent less pain, less blood loss, quicker recovery, and fewer complications compared to those who undergo traditional cystectomy. This makes the procedure an important treatment option for the more than 60 percent of bladder cancer patients who are over age 65 because many have health problems that would make them ineligible for traditional open surgery.
The Roswell Park Advantage
Roswell Park’s Minimally Invasive Surgical Center has performed more than 350 robot-assisted radical cystectomies for advanced bladder cancer, earning a place among the world’s premier academic institutions that offer the procedure.
We are proud to be at the forefront of this minimally invasive surgery, and we are the first center in the world to reach the milestone of 100 patients treated with robot assistance. – James Mohler, MD, Chair, Department of Urologic Oncology
If you have a cystectomy, you also will have reconstructive surgery. Once the bladder is removed, it is necessary to create a storage space to take over the bladder functions, and to fashion a structure that will allow you to pass urine.
Roswell Park surgeons offer three ways to achieve this:
- Urostomy: If the urethra was removed as part of the cystectomy, surgeons can create a urinary passageway by forming an ileal conduit or urostomy. A portion of the small intestine (ileum) is used to make a tube through which urine will pass through an opening to the outside of the body, called a stoma. Urine collects in a flat, disposable bag worn on the outside of the body. The bag must be emptied and replaced regularly, and the stoma cleaned and checked.
- Continent Reservoir: This procedure uses the small intestine to create a reservoir or storage pouch to collect urine inside the body. This pouch, also called an Indiana pouch, means an external bag is unnecessary. The stoma is very small and can be covered with a bandage. Inside the pouch is a one-way valve that does not allow urine to escape. Every 4 to 6 hours, you will insert a small catheter (tube) into the stoma to drain the pouch.
- Orthotopic Neobladder: In this procedure, a part of your small intestine can be used to make a new pouch (a neobladder) that is connected directly to your urethra. No stoma or external bag is necessary. Instead, the neobladder empties just as the original bladder did, with urine passing normally, through the urethra. Some people may need to use a small disposable catheter a few times a day to empty the neobladder. The catheter is placed into the bladder through the urethra.