The surgical option is part of the treatment of most bladder cancers.
There are several types of interventions possible. The choice of the operation to be performed for a given patient depends on the stage of tumour extension.
Trans-urethral resection of bladder tumor (RTV)
Trans-urethral bladder tumour resection (TBR) is usually the first intervention to be performed when a bladder tumour is suspected.
Endoscopy asserts the diagnosis and the resection material that is transmitted to the pathologist’s anatomopathologist, which allows the stage and cellular grade of the tumour to be specified, and in particular whether or not the tumour infiltrates the bladder muscle.
Trans-urethral bladder tumour resection is usually the only treatment necessary for the initial stages of superficial tumours that do not infiltrate the bladder muscle into bladder cancer.
Most patients at the time of initial diagnosis have superficial bladder tumours. It is therefore usually their first and sometimes only treatment.
However, in the event of recurrence, some patients will require a second, more extensive and deeper transurethral resection, which will be necessary to properly assess the stage of the tumour.
How is trans-urethral bladder tumour resection performed?
This surgery is performed using an endoscope that is inserted into the urethra.
This is endoscopic surgery. There is no incision of the abdominal wall or scarring.
The procedure is usually performed under general anesthesia. It is also possible to perform this procedure under local regional anesthesia of half the body, either spinal anesthesia or epidural anesthesia.
The urologist introduces a rigid endoscope into the urethra canal. It is an endoscopic resector.
This endoscope is inserted under visual control into the channel from the urethra to the bladder.
After the removal of the bladder emptying urine for a urinary cytology and a diagnostic examination under the control of the surgeon’s view of all bladder walls, the tumour is removed.
The resector has a trolley with a handle connected to the section and coagulation current of the electric scalpel, and the surgeon can use this handle to cut the entire tumour into fine chips which are then extracted from the bladder by saline washing and transferred to the pathologist for study. It is the electrical current of section and coagulation that is the energy agent usually used for this procedure.
The use of the laser is optional in this indication and has no real advantage over electric current.
Possible side effects
Possible side effects of trans-urethral bladder tumor resection are usually moderate and transient.
There may be some bleeding or urination pain in the days following surgery. Usually, the surgeon can return to his or her home the day after the operation and resume his or her usual activities quickly. The work stoppage is about one week.
When the transurethral resection of the bladder tumor has been completed, which is usually the case, bladder cancer can recur in other parts of the bladder.
It is then necessary to perform a new transurethral resection of this bladder tumour.
However, if too many intravenous transurethral resections have been performed, the bladder may become scarred and lose its reservoir capacity.
At this time, urination will become more frequent, and eventually the patient may experience urinary incontinence and not be able to control urination. In some cases of small, low-grade superficial tumours, the surgeon can simply electrocoagulate the tumour without removing it.
When bladder cancer is infiltrating, it is necessary to operate and remove some or all of the bladder.
This procedure is called a cystectomy.
In rare cases where the cancer invades the bladder muscle but the tumour is unique and rather small, it may be considered to remove only the portion of the bladder wall on which the tumour is located, with a safety collar about 2 cm in any part of the tumour implantation site.
The defect in the bladder wall, which is created by this partial resection of the bladder wall, is then closed directly.
Neighborhood lymph nodes are removed and subjected to anatomo-pathological examination to verify that they are not invaded by cancer.
In practice, for carcinological reasons, few patients whose cancer has invaded the bladder muscle are eligible for this type of surgery.
The advantage of partial surgery is that the patient retains his bladder and he does not need reconstructive surgery.
On the other hand, the drawbacks are that the residual bladder may have lost a large part of its capacity, which means that the patient will have to urinate much more often or even experience incontinence problems.
Especially the major disadvantage is that the risk of recurrence of cancer in other portions of the remaining bladder is significant.
Most of the time, in the case of infiltrating bladder cancer of the bladder muscle, the indication is to remove the entire bladder. This procedure is a radical cystectomy that removes the entire bladder and surrounding lymph nodes. A bilateral lymph node repair is therefore carried out.
In men, the prostate gland and seminal vesicles are also removed.
In women, surgery involves removal of the ovaries, fallopian tubes, uterus, cervix and vaginal cup. These elements are removed in one piece with the bladder.
This is a severe surgery that is performed under general anesthesia.
These procedures are usually performed through an incision in the abdomen.
The length of hospitalization is about fifteen days and it is necessary to consider a convalescence quite long considering the heavy nature of this surgery.
Some trained surgeons perform this operation by laparoscopy, through several small centimetric incisions.
This is endoscopic surgery.
This laparoscopy can be performed either conventionally or with the assistance of a surgical robot. It’s robotic cystectomy.
This approach results in less postoperative pain and quicker recovery of the patient due to the small incisions made. There is also less risk of bleeding and less need for transfusion.