Resection of the bladder is a surgical operation that involves the removal of part of the organ. This type of intervention can be performed on both men and women. Often, the operation is prescribed for malignant tumors of the bladder and for multiple protrusions of the mucous membrane (diverticulosis). The rehabilitation period after the operation is often associated with various complications, so such patients are prescribed a special diet and medication.
What can be a resection
The bladder is a hollow organ that is located in the small pelvis and acts as a natural reservoir for the accumulation and excretion of urine from the body. Pathologies of this organ are diagnosed in every fifth urological patient requiring surgical intervention.
Since the main indication for surgery is a cancerous tumor of the bladder, resection servesthe only viable treatment option. Patients at the stage of metastasis and diverticulum formation are not helped by any conservative methods.
Intervention is carried out by open or transurethral access. To date, surgeons perform the following types of bladder operations:
- Partial cystectomy involving open access to the organ.
- TUR - transurethral resection of the bladder.
- Endoscopic laser removal of the affected part of the organ.
Resection of the bladder can also be recommended for other diseases that are accompanied by urinary retention and are not amenable to drug therapy, in particular with trauma to the organ, the formation of polyps, stones, fistulas, ulcerative cystitis, endometriosis.
Diagnosis before surgery
Before proceeding with the surgical intervention, the patient is prescribed an examination. Diagnosis will help determine the exact localization of the affected area of the organ, the size of the tumor and its structure. For this purpose, carry out:
- Ultrasound of the pelvic organs. This is one of the simplest and most accessible types of examination, which allows you to get an objective picture of the disease. In addition to the usual abdominal ultrasound, a transurethral or transvaginal ultrasound may be done.
- Cystoscopy is an endoscopic examination procedure, which involves the introduction of a cystoscope through the urethra into the organ cavity. The device givesthe ability to view the surface of the mucous membrane and remove a tissue sample for histological examination of the existing neoplasm.
- Urine analysis for atypical cells.
- Urocystography with contrast medium.
- Computed tomography. This type of diagnosis is prescribed after the discovery of a tumor in order to clarify its size, exact location, condition of nearby organs and lymph nodes.
- Intravenous urography of the urinary tract allows you to assess the patency of the urinary tract.
Cancer can be confirmed with a biopsy. The patient's prognosis will depend on the type of formation. Even after a successful resection, the patient remains registered with an oncologist, since the possibility of a relapse is not ruled out. When malignancy is confirmed, patients should also undergo a CT scan of all abdominal organs to determine if distant metastases are present.
Not always patients have to undergo all types of research. A set of diagnostic procedures is prescribed individually for each patient. Immediately before the resection of the bladder, as well as before any other surgical operation, general clinical and biochemical tests are prescribed, blood groups and the Rh factor are necessarily determined. In addition, before the intervention, the patient must undergo a test for the presence of antibodies to HIV infection, syphilis, hepatitis, undergo an examination by highly specialized specialists andtherapist in the presence of concomitant chronic diseases.
If an inflammatory process occurs in the bladder, resection cannot be performed. In this case, the patient is prescribed an analysis for bacteriological culture of urine and treatment with antibacterial drugs. Regardless of the type of surgery, food and drink should be avoided a few hours before the procedure.
Open cavity surgery
With partial cystectomy, an incision is made in the abdominal wall. Depending on the localization of the pathology, the place of penetration of medical instruments is determined. If the tumor is located on the back wall of the organ, the peritoneum is opened and a median laparotomy is performed. In the case of an anterolateral lesion, the surgeon makes an arcuate incision, gaining access through the suprapubic area. The tissues are dissected in layers after the bladder is removed into the wound. After opening the wall, the surgeon resects the bladder tumor.
Today, this surgical technique is significantly inferior in popularity to the transurethral one. Open abdominal surgery on the bladder is resorted to in exceptional cases, when TUR is contraindicated (for example, with large neoplasms and diverticula). In addition, it is an open resection that makes it possible to carefully examine the organs adjacent to the bladder and, in case of damage to the lymph nodes, immediately remove them.
Dignity TOUR
Implies the excision of the tumor in a minimally invasive non-traumatic way, without cutting the peritoneum. Transurethral resectionthe bladder goes through several stages:
- The affected organ is filled with sterile saline.
- A cystoresectoscope, a special device equipped with a tiny camera, is inserted through the urethra (urethra) to remove a cancerous tumor or a benign polyp.
- Pathological tissues are scraped off with a cystoresectoscope in layers, up to complete removal and partial capture of the he althy bladder wall.
- At the end of the operation, the resulting material is sent for histology.
All manipulations take place under careful control due to the display of the image on the monitor. After part of the affected organ has been removed, a catheter is placed in the patient.
Unlike cavitary partial cystectomy, TUR has a number of advantages:
- tissues are much less injured;
- organ functions are fully preserved;
- lower risk of bleeding and other complications;
- faster recovery period;
- it is allowed to get up and walk a few hours after the resection;
- no risk of seam splitting.
How a transurethral resection is performed
Indication for TUR is a diagnosed cancer in the first stage:
- not growing into the muscle layer;
- tumor size not exceeding 5 cm;
- lack of metastases in the lymph nodes of the pelvic organs;
- full functionality of the urethrachannel.
In the postoperative period of transurethral resection of the bladder, frequent washings of the organ with antiseptic solutions are carried out in order to prevent its bacterial infection. If the operation was successful and the patient is on the mend, the catheter is removed after a few days, and if there are complications, they can be left for several weeks.
Full recovery from surgery will take at least three months. During this period, the patient is forbidden to lift weights, sit for a long time, it is recommended to refrain from driving a car. A s alt-free diet is mandatory.
What patients say
According to reviews, resection of the bladder by the transurethral method is completely painless. Generally, general anesthesia is not required for this procedure. Thanks to local anesthesia, pain is not felt during the intervention. The manipulation itself takes no more than an hour.
After surgery, many experience burning, urge to urinate, spasms. Similar discomfort is noted over the next few days. Within 7-10 days, blood impurities in the urine may be observed.
Hospitalization for transurethral resection lasts 2-3 days.
Contraindications for resection
In some cases, partial removal of the bladder is impractical, so doctors decide to remove the organ completely. Besides,open or transurethral resection of the bladder tumor is not carried out with severe deformation of the organ, bleeding. TUR is also not recommended in the advanced stages of cancer, when the tumor grows into all the walls of the bladder and affects nearby organs.
If a patient is diagnosed with a superficial cancer that is prone to recurrence and is not amenable to treatment with chemotherapy drugs, radiation, cystectomy is considered the preferred option. Complete removal of the organ is recommended for large neoplasms (more than 5 cm). In extremely rare cases, they resort to resection of the bladder neck - usually if the tumor is localized in this area or the vesicoureteral triangle, it is removed along with the organ.
Cystectomy
During the operation of this type, the possibility of removal of neighboring organs affected by the tumor is not excluded. Surgeons take such a step in cases where a different decision carries mortal risks for the patient.
Access to the bladder during cystectomy is obtained through a suprapubic incision. The surgeon carefully dissects all the ligaments of the organ, mobilizing it. The next stage is the ligation of all blood vessels that feed the bladder, and cauterization of the veins that carry out the outflow of blood. After that, a clamp is applied to the urethra, located as close as possible to the bladder, in order to stop it. Next, the organ is brought to the open wound, peeled off from nearby tissues and removed from the cavity.
Cystectomy is contraindicated forcritically ill patients, allowing only palliative treatment to ensure urine flow.
Laser removal of part of the bladder
Such an intervention in diseases of the bladder practically does not cause complications. Endoscopic laser treatment promotes rapid recovery. There are no consequences of bladder resection, but the possibility of short-term pain and burning is not excluded. The risk of developing erectile dysfunction after laser resection is an order of magnitude lower than after TUR. Removing part of the affected organ with a laser allows you to give the patient more favorable prognosis.
What could be the complications
Some complications may occur during or after a bladder resection.
- formation of blood clots and blockage of blood vessels;
- discovery of internal bleeding;
- perforation of the walls of the organ;
- bladder infection;
- acute urinary retention.
The success of open, transurethral and endoscopic resection largely depends on the experience and skill of the surgeon, the age of the patient and the severity of his general condition.
Feeling good after surgery
At the end of the manipulation, the patient is given a system necessary to control the functioning of the operated organ and prevent urinary retention. During the first day after the resection of the bladder, the patient is not recommended to drink or eat, but if a couple of hours after the operation there is nonausea, it is allowed to drink some water. With positive dynamics, liquid or light food can be consumed the next day. You will learn about what the patient's diet should be for the speedy recovery of strength in the next section of the article.
In order to avoid the consequences of bladder resection performed with epidural anesthesia, the patient is forbidden to rise and move during the first day. Throughout the next week, he will have to take antibiotics. After removing the catheter, discomfort, pain, frequent urge to urinate, pain and burning in the urethra may occur. Side effects usually go away after a couple of weeks. Otherwise, if the pain does not stop and blood is still observed in the urine, you should consult a doctor.
Features of the diet
Proper nutrition will not relieve pain and pain after surgery, will not help to avoid urinary retention, but it is diet that will give additional guarantees for a speedy recovery and restoration of immunity. The diet of a patient who has undergone a bladder resection includes liquid or semi-liquid food without s alt and spices.
The patient needs to drink plenty of fluids daily, but at the same time give up a number of dishes and products. Under the strictest ban any fatty, smoked and fried foods. Instead, it is recommended to use boiled or steamed poultry, rabbit, sea fish, low-fat cottage cheese.
Where to do a bladder resection in Moscow
If the patient has all the indications for the operation, he can do it free of charge in the urological departments of budgetary medical institutions.
In private clinics, the price of such operations can vary significantly. On average, the cost of transurethral resection varies from 100 to 130 thousand rubles, open cavity resection is estimated at 50-70 thousand rubles, and complete removal of the organ is more than 150 thousand rubles.
Among Moscow clinics where such an operation is performed for a fee, it is worth noting several modern medical institutions, whose patients have the opportunity to receive specialized medical care according to international standards. The staff of these clinics employs highly qualified specialists who have undergone training in the United States, European countries, and Israel. You can make a resection of the bladder in such institutions in Moscow:
- "European Medical Center" on the street. Shchepkina.
- Clinic "Medicine" on the lane. 2nd Tverskaya-Yamskoy.
- Medical center GMS Clinic on the street. Yamskoy.
- Genesis Medical Academy on Leninsky Prospekt.
- Clinic "First Surgery" on the street. Shchukinskaya.
- Traffic Clinical Hospital. N. A. Semashko JSC Russian Railways.
To improve the prognosis and prevent the development of dangerous complications, it is important to undergo thorough preparation for the operation, and after it - strictly follow all the doctor's instructions.
