Construction of Bladder Pouch after Surgery for Bladder Cancer Produces Favorable Outcomes


Construction of Bladder Pouch after Surgery for Bladder Cancer Produces Favorable Outcomes

A radical cystectomy, a surgery that involves removal of the bladder, is a common treatment for cancer of the bladder. Persons who undergo a radical cystectomy must also undergo a procedure to design a new way for the body to store and pass urine. Recently, researchers from Germany reported that their efforts to use a segment of the large bowel as a substitute bladder have produced favorable outcomes.

Cancer of the bladder is characterized by the presence of cancer cells in the bladder, the organ that is located in the lower abdomen and that serves to store urine. Treatment options, which depend on the

stage of the cancer (extent of disease at diagnosis) and a number of other factors, may include surgery, radiation therapy, chemotherapy, and/or biologic therapy to help the immune system fight the cancer. One type of surgery that is commonly used, especially for persons who have stage III or IV bladder cancer, is called a radical cystectomy. A

radical cystectomy consists of the surgical removal of the bladder as well as the tissue and some of the organs around it. For men, the prostate and the seminal vesicles, and possibly the urethra, are often removed. For women, the uterus, ovaries, fallopian tubes, part of the vagina, and the urethra are often removed.

A pelvic lymph node dissection, removal of the lymph nodes in the pelvis, may also be performed to determine whether the cancer has spread to these lymph nodes. Because the bladder is removed, doctors must design an alternate way for the body to store and pass urine. This is often referred to as a

urinary diversion technique. Sometimes, this entails using part of the intestine to construct a tube that carries urine to an opening (called a

stoma) to the outside of the body. The procedure to construct this stoma is called an

ostomy or

urostomy. Many researchers have also been studying more permanent ways to allow urine to be stored and passed without use of the bladder to help improve urinary function and quality of life. This often involves creating a substitute bladder, sometimes called a

neobladder.

Researchers in Germany evaluated the results of a procedure to construct a new bladder for patients who underwent a radical cystectomy for bladder cancer. The procedure entails the formation of a pouch, or neobladder, using a segment of the large intestine. The ureters are attached to the pouch so that the urine can be delivered to this new bladder, and the urethra is attached to the pouch at the other end so that the urine can be passed out of the body. The results showed that 85% of the patients who underwent this procedure had adequate urine storage and were able to pass urine spontaneously. Eighty-eight percent of the patients were continent during the day; 17% did require a safety pad and 9% had a problem with incontinence when stressed. Overall, only 3% of the patients experienced an incidence of complete incontinence. Sixty-seven percent of individuals were able to sleep through the night, 34% with complete continence and 33% using 1 safety pad.

The German researchers concluded that the use of a segment from the large bowel allows construction of a reasonably good pouch for a substitute bladder. Persons with bladder cancer who have undergone or are considering undergoing a radical cystectomy may wish to talk with their doctor about the risks and benefits of this approach to construction of a substitute bladder or of participating in a clinical trial in which other promising new strategies are being studied. Two sources of information on ongoing clinical trials that can be discussed with a doctor include a comprehensive, easy-to-use service provided by the National Cancer Institute (

cancer.gov) and the Clinical Trials section and service offered by Cancer Consultants.com (

www.411cancer.com). (

British Journal of Urology International, Vol 83, No 9, pp 964-970, 1999)

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