The bladder is the organ of urine storage and elimination, and a new “vessel” must be created to replace the bladder after total cystectomy. There are three main procedures that are currently popular worldwide, depending on the patient: ureteral skin ostomy, ileal outflow tract (anastomosis of the ureter and about 12 cm of ileum, with the ileal outlet anastomosed to the skin), and in situ neobladder. In the first two, the urine is merely excreted and cannot have a urinary storage function, while in the latter – in situ neocystectomy: after making a new bladder, the new bladder and urethra are anastomosed and have a urinary storage and excretion function. Externally, the ureterostomy and ileal outflow tract have no “container” to store urine, so urine comes in direct contact with the adjacent skin and a urine bag needs to be fastened to complete the urine drainage. The in situ neobladder, on the other hand, stores urine and urinates approximately as normal, with a decent appearance and no visible bladder removal. However, the creation of an in situ neobladder is a complex procedure that requires a high degree of skill and experience in controlling postoperative management.
In which cases of bladder cancer is it necessary to remove the bladder?
The indications for total bladder resection are still quite strict. Specifically, total bladder resection is preferred for muscle invasive carcinoma; refractory superficial carcinoma, i.e., repeatedly recurring superficial bladder cancer, also requires total bladder resection; others include high-grade non-muscle invasive carcinoma (T1G3, as doctors often talk about) with high risk of progression, carcinoma in situ that has failed to respond to BCG treatment, and extensive papillary lesions that have failed conservative treatment. Then there is the squamous or adenocarcinoma of the bladder.