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 Maryland reported success with a procedure to construct a new bladder.
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 at Johns Hopkins University reviewed their results, from 1986 to 1998, of a procedure to construct a new bladders for persons who had undergone a radical cystectomy for bladder cancer. This procedure entailed the use of a segment of the intestine between the ileum (last part of the small intestine) and colon (part of the large intestine) to form a new bladder, referred to as an ileocolonic neobladder. The results showed that 76% of the patients were continent during both the day and night. Three percent had a problem with involuntary urination at night, and 3% had a problem with involuntary urination when stressed. Fifteen percent of the patients needed to be catheterized intermittently. Forty-five percent of men undergoing the procedure remained sexually functional afterward. Complications of the procedure included early complications in 11% and later complications in 30%.
From these findings, the researchers concluded that their construction of the ileocolonic neobladder for persons who had undergone a radical cystectomy produced positive results. These findings warrant further study to compare this procedure with other approaches to bladder reconstruction. 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 construction of an ileocolonic neobladder or of participating in a clinical trial in which other promising new approaches are being studied.
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