TRANSURETHRAL SURGERY
A transurethral resection of a bladder tumor (TURBT) is the most common surgery for bladder cancer that is superficial or at an early stage. In a TURBT, the tumor is removed using a cystoscope placed in the bladder through the urethra. This may be done under regional or general anesthesia. The tumor may be “burned” in a procedure known as fulguration, which uses an electronic current to kill tissue. A high-energy laser and a cystoscope can also be used to destroy the cancer. No incision on the abdomen is needed.
A TURBT usually produces only mild side effects that do not last long. They include bleeding and discomfort following the operation. A patient can usually return home on the same day of the procedure or the day following. Normal activities may be resumed in one to two weeks.
CYSTECTOMY
A cystectomy involves making an incision through the abdomen to remove the diseased area. This is usually done in cases where bladder cancer is invasive.
Where only the tumor and part of the bladder are removed, which may be done in rare cases where the cancer is not very large, the procedure is called a partial cystectomy. A radical cystectomy is a procedure in which the entire bladder and nearby lymph nodes are removed. This is carried out when the cancer is large or when more than just one area of cancer exists.
For men, a radical cystectomy may involve removal of the prostate. For women, the uterus, ovaries, fallopian tubes, and a portion of the vagina may be removed together with the bladder.
Both procedures are done under general anesthesia, and require a hospital stay of seven to 10 days. Usual activities may be resumed in four to six weeks.
Possible side effects include urinary tract infection, urinary incontinence, excessive bleeding, and blocked urine flow. When the entire bladder is removed, reconstructive surgery will be needed so that the body will have a way of storing urine.
A radical cystectomy may have an adverse effect on patients’ sexual function. It could lead, for instance, to a patient losing the ability to produce semen, since the prostate gland, which is responsible for producing most of the seminal fluid, is usually removed during the procedure. This removes the means by which sperm cells leave the body. Instead, they are simply reabsorbed. Thus, orgasms become “dry”, that is, without semen.
Impotence is another possible side effect. This occurs when the nerves responsible for penile erections are damaged during surgery. The ability to have spontaneous erections, however, may return eventually. The chances for recovering sexual function are higher for men under 60, especially those who are under 50 years of age.
There is some contention in medical circles on when to perform a cystectomy. Some doctors advocate bladder preservation, using TUR followed by chemotherapy and radiation therapy. In these cases, patients would still have the option of removing the bladder later on, especially if they do not respond to TUR and subsequent therapy. Other doctors, however, recommend cystectomy even for some patients with bladder cancer at an early stage.
Whatever the case may be, it is important for patients to be fully informed of the available options.
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