Bladder tumors are common tumors in the urinary system. For patients with early or mid-stage bladder tumors, surgery is usually performed. There are 3 types of these surgical procedures, transurethral resection of bladder lesions, partial cystectomy, and total cystectomy.
Each type of surgery is different from the other. So what is the basis for deciding on the surgical procedure as a doctor? Here are the indications for each type of surgery.
I. Transurethral resection of bladder tumor (TURBT) When there is a low stage, solitary, well differentiated and non-invasive cancer, we will take transurethral resection of bladder tumor (TURBT), For tumors larger than 3 cm, although this procedure can also remove the cancer directly from the root, it is difficult to remove the excised tissue from the bladder, so this procedure is not recommended.
Partial cystectomy is suitable for patients whose tumors are limited and show infiltrative growth, and the lesions are located in the lateral posterior wall and top of the bladder, and are at a certain distance from the bladder triangle. Partial cystectomy is performed with a scalpel or high-frequency electric knife at a distance of 2 cm from the tumor to remove the part of the bladder wall with the tumor as the core, and some adherent tissues are removed together. After resection, the bladder edges are sutured together.
Third, total cystectomy (Cystectomy) After total removal of the bladder, it is inevitably accompanied by urinary flow diversion. As the name implies, urinary diversion means that the patient’s urine is not discharged from the original urethra after surgery, but from the abdominal wall or intestine; or the artificial bladder is placed in the original position of the bladder, connected to the ureter above and the urethra below, which is usually called “in situ neobladder”. So what kind of surgery is an in situ neobladder? It involves the surgeon removing the bladder and finding a “new reservoir” to replace it, usually by intercepting a section of the ileum or colon and anastomosing it to the urethra and ureter so that it can store urine.
Urethral diversions are divided into uncontrolled and controlled urinary diversions, depending on the function of the postoperative artificial bladder. Uncontrollable urinary diversions include Bricker ileocecal cystostomy and ureteral skin stoma; controllable urinary diversions are Kock ileocecal cystoplasty and in situ ileocecal cystoplasty via abdominal wall stoma. After ligating the urethra, the ureter is directly dragged out to the abdominal wall and two stomas are made. It does not pass through the ileum or colon, but directly drains urine from the ureter.
In addition, bladder tumor can also perform urofecal colectomy, which is an anastomosis and stoma between ureter and colorectum, but it is now gradually eliminated due to the disadvantages such as easy occurrence of upper urinary tract infection and the need to wear a fecal stoma bag.
How to choose the surgery?
Generally in situ neobladder is suitable for patients who are younger and have requirements for their image, but its disadvantage is that the amount of urine stored in the bladder will be reduced and sometimes they cannot control urination on their own. A total cystotomy ileal bladder is indicated for those with good function in all aspects of the organism; a total cystotomy ureterodermatostomy is indicated for some older patients with low function in all aspects of the organism. Therefore, it is necessary to listen to the doctor’s advice and choose the specific surgical procedure according to your actual situation. In fact, the surgery of bladder tumor is different but similar, the purpose of which is to remove the lesion and let everyone live a healthy life!