What abnormalities should be suspected of bladder cancer?
Painless hematuria is a characteristic manifestation of bladder cancer. It is a unique “abnormal urination sign” of bladder cancer and occurs in almost every patient. Hematuria is usually complete, but it can also occur at the beginning or end of urination. The hematuria can be intermittent and can reduce or stop on its own, creating the illusion that the disease has healed, but often the bleeding will return soon. In addition, a small number of patients have symptoms of “cystitis” like increased urination, urgency and painful urination. If the symptoms do not resolve after anti-inflammatory treatment, you should be alert to the possibility of bladder cancer. If the tumor has invaded the ureteral opening, it will also produce hydronephrosis and cause symptoms of back pain, lumbar pain and swelling. Therefore, for any suspicious symptoms of urinary system, one should be alert to the possibility of bladder cancer.
What are the post-operative health care of bladder cancer?
Post-operative health care of bladder cancer includes.
① Patients with preserved bladder should be reviewed for cystoscopy once every 3 months for 2 years after surgery, and changed to once every 6 months for those without recurrence within 2 years. Other optional reviews include urinary exfoliative cytology, intravenous urography, urinary routine, ultrasound and CT.
② Daily care and health care for patients with ileocecal bladder crossing: As the patient’s urine flows from the abdominal wall ileostomy, a urine collector needs to be permanently placed. The urine collector consists of two parts, the sump and the urine bag, and the sump is usually replaced once in several days, and the urine bag is replaced once in 1-2 days.
Care should be given to.
(1) Those with permanent dermatostomy should protect the skin around the stoma, wash and disinfect it daily, and apply zinc oxide ointment, etc. externally.
(2) If flocculent mucus is found in the urine, drink more water and take oral baking soda tablets to alkalize the urine and thin out the mucus to facilitate smooth urination.
(3) comprehensive review every 3 months for 2 years after surgery and every 6 months after 2 years.
(4) Pay attention to the occurrence of retrograde urinary tract infection, and if there is sudden high fever, timely hospital consultation is also required.
(5) If there is bloody discharge from the urethra, be alert to the possibility of residual or occurrence of urethral tumor, and come to the hospital promptly.
(3) Daily care and health care for patients with in situ ileal substitution bladder: Since urine is still discharged from the original penile urethra, in order to prevent the occurrence of urinary incontinence should be done lifting muscle training to exercise the perineal and pelvic floor muscles, 30 times for 1 set, complete 30 sets daily. Initially, you should urinate once every 2 hours in a sitting position, relax the pelvic floor muscles, add pressure to the abdomen, make sure to drain the urine every time you urinate, and apply an alarm clock to wake up every 2 hours at night to urinate on time. 3 to 6 months later, gradually extend the interval between urination to 3 to 4 hours, change to standing urination, drink 2 to 3 liters of water daily, and eat more salt appropriately. Within 6 months after surgery, liver and kidney function and electrolytes should be checked every 1~2 weeks to prevent electrolyte balance disorder. A comprehensive review should be conducted every 3 months for 2 years after surgery and every 6 months after 2 years. All patients should quit smoking and also develop a good habit of drinking more water, 2 to 3 liters of water per day.
Will bladder cancer not recur after bladder infusion chemotherapy?
Will bladder cancer not recur after bladder irrigation chemotherapy? No. After bladder cancer is resected by TURBT, 60-70% of patients will eventually recur if they do not undergo subsequent infusion chemotherapy. Bladder infusion chemotherapy can significantly reduce the recurrence rate to about 20-30%, which means that a large proportion of tumors are eradicated by bladder infusion chemotherapy. Those patients who recur will need to be treated with surgery again.
What is bladder infusion chemotherapy?
Bladder infusion chemotherapy is a type of intravesical chemotherapy in which a catheter is inserted down the urethra into the bladder, then the chemotherapy drug is injected into the bladder and kept in the bladder for 1/2 to 2 hours (depending on the drug, the doctor will tell the patient exactly how much time to keep the drug in the bladder depending on the drug). During drug retention, the patient should try to keep all of the bladder mucosal epithelium immersed in the chemotherapy drug and may be turned at regular intervals (prone, supine, right and left lateral and sitting positions). As soon as the retention time is up, urine should be drained and plenty of water should be drunk. If the perfusion retention time exceeds the predetermined time, the chemotherapeutic drugs are likely to burn the bladder mucosa and form chemical cystitis with symptoms such as urinary frequency, urinary urgency, painful urination and hematuria, which will take 1 to 2 weeks to return to normal and affect the continuity of perfusion chemotherapy. Therefore, patients must listen to the retention time told by the doctor and must not perfuse overtime.
The general routine protocol for bladder perfusion is: first 1 time per week for 8 times after surgery; review cystoscopy without abnormality, change to 1 time every 2 weeks for 6 times; then review cystoscopy without abnormality, change to 1 time per month for a full 2 years.
If chemical cystitis does not occur, bladder perfusion is almost painless; it is only a local drug that does not cause toxic side effects of intravenous chemotherapy such as vomiting, hair loss, white blood cell drop and liver and kidney function damage, and is basically harmless to the human body.
The entire bladder was removed, what will I do for future urination?
After radical total cystectomy, the original normal urinary route is completely destroyed, so how can urine be led to the outside of the body for excretion? There are two main methods.
Ileal bladder passage: A 15-cm-long section of ileum is taken as a channel for urine to flow out from the right abdominal wall, and the patient must wear a urine bag for life, or catheterize regularly on his own. This method causes a lot of inconvenience to the patient, requires constant care, and smells like urine if it is not cleaned properly. However, the surgical technique is relatively simple.
In situ ileal substitution bladder surgery: The ileum of about 50cm long is sutured to look like a bladder and repositioned back to the original bladder position, restoring the normal physiological urinary route, and urine is also discharged from the original penile urethra without the need to wear a urine bag, with higher quality of life. The surgical technique is relatively complex, but it is already a routine and mature procedure. Postoperatively, patients report good results, generally without incontinence, and various urodynamic measurements are similar to those of a normal bladder with good function.
Of course, the exact type of urination to be performed depends on the specific extent of tumor invasion.
What is TURBT procedure?
TURBT stands for transurethral resection of bladder tumor. It is a minimally invasive surgical procedure in which a small, high-energy electric knife is used to cut the bladder tumor into pieces and then flush it out of the bladder with water through a cystoscopic operation. It has the characteristics of removing tumor safely, completely and efficiently; because of the small trauma of the operation and quick recovery, it has become the treatment of choice for superficial bladder tumor surgery.
Who are prone to bladder cancer?
Bladder cancer is the most common malignant tumor in the urinary system, ranking eighth in the list of top ten malignant tumors in China, and is common in patients over 50 years old. Bladder cancer is known as environmental tumor and is closely related to the external environment. Risk factors for the development of the disease include: environment, occupation, urinary tract infection and chronic inflammation, bladder stones, bladder foreign bodies, pelvic radiation therapy, etc.
At present, the clear carcinogenic chemicals include 2-naphthylamine, benzidine and 4-aminobiphenyl, all of which are chemicals containing benzene rings. The corresponding hazardous occupations are: dye, textile, rubber, paint, truck driver, chemical, oil, hairdresser, aluminum factory, etc. Bladder tumors are closely related to gender, with the incidence being 2-10 times higher in men than in women. Regardless of gender, smoking can greatly increase the chance of bladder cancer, mainly because smokers have higher levels of the carcinogen tryptophan in their urine.
People with the above-mentioned predispositions should go to an oncology hospital as soon as they experience any discomfort, especially hematuria.
I heard that cystoscopy is uncomfortable and painful, can I skip it?
Cystoscopy is a must if the doctor suspects a bladder abnormality, because it is the clearest and most visual way to thoroughly identify any abnormality in the bladder, and there is no substitute for any other examination method. Based on the results of cystoscopy, the doctor has to determine whether the patient needs surgical treatment, what kind of surgery is needed and whether the bladder can be preserved, which is very important for the patient and relates to the patient’s quality of life after surgery. Moreover, after the surgical treatment of early bladder cancer with bladder preservation, regular cystoscopy is still needed to clarify whether there is tumor recurrence. Therefore, cystoscopy is an indispensable test in the diagnosis and follow-up of bladder cancer. Cystoscopy does cause mild discomfort, especially when the patient is very nervous. Doctors will use anesthetic in advance before the operation. Basically, all patients can complete the examination successfully as long as they relax and cooperate with the doctors.