Most often, surgery to remove the bladder in men and women is performed against the background of oncological disease of this organ. If the cancerous processes that began in the mucous membranes have spread to the muscle walls, resection is indicated. Currently, among other malignant pathologies, localized in the bladder is quite common, only slightly inferior to the degeneration of the prostate gland. The disease is characterized by a latent course. The first symptom that makes her suspect is bloody inclusions in the urine.
When shown?
Surgery to remove the bladder is recommended for those who, after primary surgical intervention for diagnostic purposes, have received laboratory histological results confirming the spread of atypical cellular structures outside the mucosa. If there is a penetration of degenerate areas into muscle tissues,it is recommended to remove the organ as soon as possible.
The main reason for an operation to remove the bladder is the risk of additional foci and affected areas. Pathology is considered multifocal, if the organ is not removed, it will eventually manifest itself in its other area. If such processes have covered muscle tissue, the probability of metastases is estimated at 50%. The spread of the pathological process can be suspected if the patient notes a violation of the urinary act, the study shows the growth of the pelvic lymph nodes. It is possible to form areas of rebirth in the skeletal system, liver.
Features of the case
Before starting an operation to remove the bladder, the tumor must be clearly localized, specifying all the features of the pathological process. A systematic study of the state of the body is shown. A mandatory instrumental measure is CT of the abdominal cavity, sternum, and pelvic area. Scintigraphy is recommended for bone skeletal examination. The task of doctors is to determine the location of metastases or exclude their presence. If metastases are detected, it is necessary to continue the course of chemotherapy.
Removal of the bladder in women, men is performed in order to remove the tumor process from the body. The lymph nodes are removed from the pelvic region. This event simultaneously pursues therapeutic purposes and is necessary to clarify the condition - a tissue sample is sent for a histological examination.
One ofThe tasks of the planned event are to provide such a variant of urine diversion, in which the potency is preserved. In some cases, tissue from the small intestine is used for this. The bubble can be reconstructed from intestinal tissues, it is possible to make a reservoir from the small intestine. The possibility of installing a catheter remains.
To whom do they do it?
If, as part of the treatment of a tumor, the removal of the bladder seems to be the most effective and promising option, the patient's condition is first assessed in order to clarify whether the operation in a particular case is possible and acceptable. It is necessary to remember about the inoperability of some cancer patients. If invasive cancerous processes are detected, the tumor is large enough, local removal does not seem feasible, the only option is organ removal. Such an event is indicated if the patient is recommended a combined therapeutic course - surgery and chemotherapy.
Removal of the bladder for cancer is considered a complex, time-consuming, labor-intensive operation. The rehabilitation period takes a long time. This imposes a special responsibility on the doctor who decides to advise the patient to agree to the intervention. When evaluating forecasts, the presence of chronic diseases - ischemia, arrhythmia, stroke, diabetes - is taken into account. An important aspect is the age of the patient. Surgery is possible only if a person is under 70 years old, his renal system is working normally. For patients older than this age, reconstruction is not recommended, since the vast majority show weaknesssphincters, which in the future will lead to urinary incontinence.
How is it going?
The bladder removal procedure requires general anesthesia. During the intervention, doctors remove the bubble directly, remove the lymph nodes from the pelvic area. Men are shown removal of the seminal and prostate glands. If the patient's erection was normal before the intervention, doctors take measures to preserve the nerve fiber responsible for this. If the procedure is performed on a woman, it is usually recommended to remove the uterus and ovaries. As statistics show, it is here that metastases are most often detected in malignant processes localized in the bladder.
When the resection is completed, it is necessary to choose the best way to divert urine. The ureter may be fused to the abdominal wall or lead to a new bladder reconstructed from intestinal tissues. A specific option is chosen based on the characteristics of the procedure for removing the bladder for cancer. They take into account how old a person is, what condition he is in, what surgical interventions were previously transferred. An important aspect is the presence of intestinal pathologies. Often, even before the operation, the doctor, together with the client, decides on the best option.
Resection: before, during and after
Before starting the removal of the bladder, the patient should be prepared for the intervention. Assign a course of laxatives to cleanse the intestinal tract. As a rule, this is enough. The duration of the operation itself varies about five hours, possibledeviations are usually within an hour up and down. After the event is completed, the patient is transferred to the intensive care unit, intended for people who have just been operated on, where the condition is monitored for at least a day. The initial recovery period involves intravenous infusion of analgesics and other drugs necessary in a particular case.
A few days after the removal of the bladder, the intestinal tract returns to normal. A week after the event, temporary stents must be removed from the patient's body. After another week or one and a half, the person is discharged from this department. If the patient received a reconstructed bladder, he is shown a second appointment after ten days - temporary catheters should be removed from the body.
Rehab
As is known from statistical studies, after removal of a bladder tumor, accompanied by reconstruction of the removed organ, up to 95% of patients can normally control urination during the daytime. Several months are needed to develop control skills at any time of the day. The main percentage of patients who have undergone surgical procedures successfully master the skills of bladder control, regardless of the time of day.
Erectile function is largely determined by the potency of the patient before the intervention. Important aspects will be the age and characteristics of the event. In some cases it is not possible to remove the bladder in such a way that the nervous system remainsin original condition. If it was not possible to save the nerves, after the removal of the bladder, the man will not have the desired sexual power.
Diagnoses and treatment: features of the issue
Invasive is such a cancerous process, in which pathological changes cover not only the mucous membranes of the organ, but also the layers located under them, including the muscle. In the patient's diagnostic chart, the diagnosis will be recorded with stage T2 or more. Such a disease requires intensive treatment of the patient. Resection is currently the only reliable method that gives relatively good results. The operation helps to bring the case under control, reduce the risk of relapse. The official name for bladder removal surgery is radical cystectomy.
The operation is recommended if an invasive cancerous process is established, and metastases or not, or only regional ones are detected, those that can be removed during the operation. In some cases, removal of the bladder in men, women is practiced if superficial cancerous processes are established. Resection is indicated if transurethral surgery has been performed, after which there have been several relapses. They can prescribe an event in case of a large area of lesions and the spread of the pathological process to the prostatic zone of the urethra.
Diagnoses and patients
Sometimes the removal of the bladder for men, women is indicated against the background of flat cancer. Surgery is prescribed if intravesical immune treatment, chemotherapy approach is not givendesired outcome.
This type of intervention is useful in T1, an early stage of the malignant process, under the condition of low differentiation of degenerate cells. For such a disease, the risk of recurrence is assessed as high.
When cancer is diagnosed at a late stage, resection may be used to improve the patient's condition, reduce pain and improve quality of life. The event is aimed at eliminating the main symptoms - frequent urge to urinate, bleeding. The measure is considered palliative.
Nerve sparing intervention
Men are more often interested in such an operation. In an impressive percentage of cases, the removal of the bladder is associated with a malfunction of the bundles of nerve fibers and blood vessels that feed the reproductive organs, and after the operation the patient becomes impotent. If erectile function was good before the event, the patient is usually interested in maintaining it. The recommended intervention will be similar in many ways to a nerve-sparing prostatectomy.
In addition to the obviously positive aspect of preserving the nervous system, there is a possibility of undesirable consequences - removal of the bladder in men may not give the desired cure, the likelihood of atypical degeneration foci remaining in the body increases. An operation that allows you to keep the nervous system of the reproductive organs normal automatically significantly worsens the prognosis of the case. Doctors, when selecting persons for such an intervention, are obliged to assess all the features of the condition as responsibly as possible. Keeping nervoussystem is possible if invasive oncological processes are localized in the posterior region, on the side or in the trigonal plane. In the absence of an invasive process and the need to remove the bladder on the background of cancer, nerve preservation during bilateral surgery is possible if the pathology is localized on the dome of the bladder, the wall in front.
Responsibility is the key to success
Both before and after the operation to remove the bladder, the patient is shown a course of specialized treatment. Radiation therapy, chemical treatment before the event is carried out in order to reduce the size of the neoplasm, reduce the volume of tissues that need to be removed from the body. After the intervention, the decision to continue such treatment is made, focusing on the characteristics of the case.
Neoadjuvant drug treatment followed by total resection has become increasingly common in recent years. Many note that this approach is one of the most promising. Considering the consequences of bladder removal, the likelihood of recurrence and other technical issues, many agree that it is this format that will be recognized as the standard approach for invasive oncological processes in the bladder in the near future. Studies have clearly shown that the combination of preliminary chemotherapy with subsequent radical resection significantly increases survival, and the difference is especially clear among patients in whom cancer was detected at stages T3, T4.
Features of supporting measures
Sometimes a doctorassessing the condition (for example, after removal of the uterus) of the bladder affected by oncological processes, recommends that the patient agree to a course of radiation. This kind of treatment before surgery generally has little effect on the results of resection. Therapy increases the likelihood of complications during surgery, complicates the formation of a reservoir for urine, if it is decided to use intestinal tissues for this. If earlier radiotherapy was the standard beginning of the course, recently it has been resorted to only if there are strict indications.
As can be seen from medical reviews, the removal of the bladder is an event of increased complexity, so it is important to carefully examine the patient's condition. It is necessary, if possible, to improve the he alth of the patient - as far as it is realistic, based on the starting conditions. If a patient has diabetes, chronic high blood pressure, anemia or another disease, it is important to responsibly compensate for the pathology. A month before the operation, alcohol and tobacco products are completely excluded. This will improve the condition of the body, reduce the likelihood of complications on the background of anesthesia.
Intestinal tract: why is it so important to prepare?
If it is planned to carry out a resection in such a way that, as a result of it, a bladder from intestinal tissues will be restored in the body, it is important to take the preparation for the intervention especially responsibly. The intestines should be as absolutely clean as possible. Three days before the scheduled event, they begin to eat liquidproducts, mushy. 36 hours before the intervention, you should drink water, but do not use any dairy products. Juices are allowed. For a day it is shown to take laxatives, put an enema.
Cleansing measures involve the exclusion of pathological microflora - decontamination. For this, the patient is prescribed antibacterial compounds that are active in the intestinal lumen. Such therapy allows you to completely destroy microscopic life forms.
Safety First
It is necessary to inform the attending physician, and before the operation, the person responsible for pain relief and the surgeon, if a person is taking vitamin E, aspirin or preparations containing it, if the patient has used Plavix or Agrenox, as well as similar medications that weaken the ability blood to clot. A week or two before the planned operation, the patient should stop using these drugs so that the likelihood of unwanted bleeding is minimal. If it is impossible to completely eliminate medications, reduce their dosages to the minimum possible.
Any surgical intervention that affects the pelvic area is associated with a high risk of complications caused by the formation of blood clots. To reduce the risk of undesirable consequences, the patient is given low molecular weight heparin medicines as a preventive measure the day before. In addition, the groin area is shaved to minimize the chance of infection. The absence of hair significantly improves the ability to maintain sterility.
And on the eve of the operation, and in the morning before it, the patientfood and drink are strictly contraindicated. If this rule is neglected, anesthesia can provoke serious complications. The event obliges the patient to be given general anesthesia. During the period of manipulation, a person does not regain consciousness, and ventilation of the lungs is provided by connecting to a breathing apparatus. To minimize the dangers, you should trust your he alth to a clinic with modern equipment. In this case, there is no doubt that all performance indicators of internal systems and organs will be read in a timely and accurate manner.
Features
In some cases, epidural anesthesia is recommended to improve the effectiveness of general anesthesia. For its implementation, a catheter is placed in the back. This type of anesthesia helps to relieve discomfort both during the period of surgical procedures and for several days after it.
In a reliable clinic, all activities related to anesthesia are implemented by a highly qualified anesthetist. This doctor may also be qualified as a resuscitator. Before the start of the surgical intervention, the specialist examines the patient, discusses the features of the anesthesia being performed, reports all the risks, possible undesirable consequences. Only if the patient is aware of them and agrees to the conditions, which he confirms with his signature on a special form, the surgeon begins to work. Often in the evening of the day preceding the operation, the patient is given sedatives. It helps to get rid of tension, the mental state becomes morecomfortable.
Technical aspects of operation
The first step of the surgical procedure is anesthesia. The doctor installs and debugs equipment that reads important functions of the body's performance. Once monitoring is established, the patient is placed on the operating table. At this time, the person is already asleep. Men are usually operated on, laying on their backs. For working with women, the optimal position of the client is lithotomy. The patient is laid on her back, the legs are brought to the body and placed on the stands reassigned for this. Then a catheter is placed in the bladder. As soon as the field for the event is ready, a standard incision is made to the navel, sometimes higher, while the navel itself goes around.
The main principle of resection is radicalism. And the affected organ itself, and all the lymph nodes, and nearby tissues covered by malignant processes, must be removed one-time as a whole block. An equally important principle is ablaplasty, that is, the prevention of the spread of atypical cellular structures through the wound throughout the body. The doctor, guided by the regulations of the event, takes measures to reduce the likelihood of such a complication. The third key principle is antiblastics. His idea is that all atypical cells scattered over the wound surface must be destroyed. To do this, the area is washed with medical alcohol, iodine solution or other suitable preparation.
Wrapping Up
Surgical measures involve the removal of the bladder, lymph nodes, tissues, while it is importantadhere strictly to the stated principles. The process is lengthy, but it is not exhaustive. Next, the doctor forms the path along which urine will be excreted. The final step is suturing the wound. Catheters and a drainage system are left here. All sutures are fixed with sterile dressings. The removed organs and tissues must be studied in the laboratory.
When the effect of the painkiller wears off, the patient is transferred to a dedicated ward, after which – to the general intensive care unit. It is noted that even in the case of a successful operation and a good recovery period, patients often become withdrawn, avoiding society, and insecure.
