Patients usually feel anxious and confused after the occurrence of hematuria. How can we reduce the trouble and pain, and keep bladder cancer from being missed? According to Jian Huang, the following tests can be reasonably chosen: Urinalysis: It is easy and quick to find out whether there are blood cells in the urine and whether there are co-infections; although it cannot confirm whether there is bladder cancer, it can help doctors understand the potential causes of hematuria.
Ultrasound of the kidney and bladder: a painless imaging test that can detect the presence of masses in the kidney and bladder as well as their number, size and distribution; it can also identify other causes of hematuria, such as bladder stones, prostate enlargement, etc.
General cystoscopy: After the ultrasound examination reveals the swelling in the bladder, cystoscopy can be placed through the urethra to understand the status of the swelling in the bladder visually, and some tumor tissues can be clamped for pathological examination to confirm the diagnosis of bladder cancer and its malignancy.
Fluorescence cystoscopy: Fluorescence cystoscopy is highly sensitive and can detect lesions that cannot be detected by ordinary cystoscopy. Studies have confirmed the high specificity of fluorescence cystoscopy in the diagnosis of bladder cancer; when in situ bladder cancer is suspected or when urine cytology is positive but normal by ordinary cystoscopy, further examination by fluorescence cystoscopy should be considered.
Pelvic CT or MRI examination: it can not only understand the distribution of tumor, but also, more importantly, the extent and degree of outward growth of tumor, as well as the information of lymph node metastasis, which is important to help in the staging of bladder cancer and the selection of treatment.
Small incision in early stage solves major surgery Does all bladder cancer require bladder removal?
It depends on which type of bladder cancer it is. There are two main types of bladder cancer: one is superficial bladder cancer, which grows on the bladder wall like watercress with shallow roots and usually does not invade the bladder muscle layer. The other is invasive bladder cancer, which is tree-like with deeper roots and often invades the muscular layer or even the whole bladder wall, and is prone to local and systemic metastases. If you have superficial bladder cancer, you usually do not need to have a cystectomy, you can insert a cystoscope through the urethra and remove the tumor with an electric knife or laser, no incision is needed. However, some tumors are so small that they do not even grow out of the mucosal surface, which is medically called “carcinoma in situ”, and these tumors are not easily visible. To increase the accuracy of cystoscopy, fluorescent staining is used before cystoscopy, called fluoroscopy.
In the case of invasive bladder cancer, the entire bladder is often removed and the pelvic lymph nodes that may have metastases are also removed, which is a more invasive and bleeding procedure. In order to reduce trauma, laparoscopic radical bladder cancer resection has emerged in recent years, which only requires a few small holes in the abdominal wall and then removes the bladder under laparoscopy, resulting in less bleeding, less trauma and faster recovery after surgery.
There are three ways to urinate after removal of the bladder How to discharge urine after the bladder is cut off has been a research topic in urology, according to Jian Huang, it can be broadly divided into three types: urination through the abdominal wall stoma, urination through the anus and urination through the urethra. Transabdominal wall stoma urination: This is a classical method, but it can have some impact on the patient’s appearance and care because of the need to bring a urine collection bag.
Transanal voiding: This involves connecting the patient’s ureter to the rectum, and the patient’s urine is then passed through the anus along with the stool after the procedure. The disadvantage of this method is that the number of bowel movements increases, and some patients have incomplete urinary control and are prone to urinary tract infections.
Transurethral urination: It is called in situ neobladder surgery in which the patient’s own intestines are used to redo a bladder attached to the urethra and can urinate on their own after surgery. This method is closest to the normal physiological state and has a higher quality of life after surgery, although not all patients can use this method. It requires that the tumor does not grow on the urethra, the surgery can remove the tumor completely, the patient does not have urethral stricture, and the urinary control function is good before surgery, etc.