- May 31, 2020
- Posted by: Prof Dr Coşkun Şahin
- Category: Bladder Diseases
What is Bladder Tumor?
Tumor development in the bladder. At ﬁrst, it grows in the form of mulberries towards the bladder cavity, if it does not show, it will take the appearance of cauliﬂower and if it is not noticed and spreads to distant organs, it can be fatal.
Classiﬁcation of the tumor in the bladder according to its depth. Tumor; Ta is limited in the inner layer of the bladder. This is the best tumor. T4 is the worst tumor where the tumor invaded the bladder muscle and overﬂowed outside the bladder.
What are the Symptoms of Bladder Tumor?
Bladder cancers may not show symptoms at the beginning and may be insidious. The ﬁrst symptom is usually bleeding from the urine. It is necessary to consider bleeding in a patient who is over 50 years old and smokers. Bleeding can be either fresh red or burgundy. Other than bleeding, there may be burning in the urine, clotted urine, inability to urinate. A ﬂank pain may mean that the disease is progressing.
The tumor in the bladder usually appears in the form of cauliﬂower or sea coral.
What Causes Bladder Tumors?
The biggest reason is smoking. In addition, chemicals, tar, substances in paint, can be the cause of bladder cancer.
What Are the Risk Factors of Bladder Tumors?
Familial genetic factors, radiation exposure, aging, smoking.
What happens if bladder tumor is not treated?
Bladder cancers develop slowly and insidiously. If it is caught early, that is, the cancer has not spread to the deep layers of the bladder yet in the bladder, its treatment is possible without taking the bladder. If it has spread to the wall of the bladder, then treatment is possible only by removing the bladder. But if the disease has metastasized, the chances of curative destructive treatment will be lost and only a little longer can be achieved with chemotherapy.
What are the Methods of Investigation of Bladder Tumor?
If bladder cancer is suspected, ﬁrst of all, if complete urine analysis, ultrasonography and tumor are detected, Tomography or MR is performed in necessary cases. The exact diagnosis is made by looking into the bladder called cystoscopy with an optical instrument. In some cases, this is often not necessary when taking a biopsy, and the entire tumor is scraped as much as possible.
How Is Cystoscopy Performed In Bladder Tumor?
It is a 15-minute procedure performed with local or general anesthesia. The patient can go home immediately after a local anesthetic. It can be done in ofﬁce conditions.
What are the treatment methods when bladder tumor is detected?
TUR –MT (Transurethral bladder tumor resection): If possible, all the tumor in the bladder is scraped with general or regional anesthesia. In some cases, the tumor has ﬁlled the bladder, and only pathological samples are taken in these patients. It is very important to take a sample from the bladder wall and tumor base with the correct method. Otherwise, the patient may be taken to an unnecessary surgery again.
In TUR operation, the tumor is scraped using the endoscopic closed method. A sample is taken from the tumor base and sent for pathological examination.
How is Post-Surgery Follow-Up in Bladder Tumor?
If the result of pathology is only a tumor in the superﬁcial layer, the patient is very lucky. 70% of patients actually fall into this group. Then, depending on the type of tumor, medication can only be given for up to 6 weeks in either a follow-up or bladder. Patients are followed up with cystoscope (looking into the bladder with an optical device) every 3 months in the ﬁrst year and every 6 months in the next years.
Radical Cystoprostatectomy (Complete Removal of the Bladder with Prostate):
If the tumor has spread to the muscle layer of the bladder, then closed surgery will not save the patient. Surgery is required, with the entire bladder and prostate removed. This surgery takes 4-6 hours. The patient lies for 7-10 days. After pathology, either follow-up or chemotherapy and / or radiotherapy are added to the treatment.
The size of the tumor is seen in the bladder opened after radical cystectomy.
Where Are The Urinary Tract Connected When The Bladder Is Taken?
The most preferred method is ileal conduit. That is, the urinary tract from both kidneys is connected to a small intestine of 10 cm. The other end of the bowel is also sewn to the abdominal wall. It is an easier and faster method. Complications during and after the surgery are less. However, the biggest disadvantage of this method is carrying bags outside the body and the difﬁculty of accepting this situation.
Urine collection bag outside the body in ileal conduit method
How Does Bladder Making From the Bowel Work?
For this, we usually take a section of 50 cm from the small intestine in the surgery and fold it in itself and make the bag, and connect the urine canals to this bag, and the bag to the penis canal called the urethra. The operation takes 6-7 hours. The hospital stay is about 8-10 days. Thus, the patient does not have to carry a bag in the womb. The social compliance of the patients is quite good due to the preservation of the body integrity. We prefer this method in suitable patients
A small intestine of 50 cm is separated from the intestine for bladder construction.
The separated intestine is folded in W shape and the bag is made
The created bag is sutured to the urethra (Urine channel)
Not suitable for: Those who are old and who have a tumor in the prostate, are not candidates for this method.
What are the Side Effects Related to the Operation in Bladder Tumor?
Bleeding, bloody urination, urinary tract stenosis, urinary incontinence, and erection problems are the most common side effects. Some of them develop depending on the patient, some on the surgeon, and some on the method. Daytime urinary retention is complete in patients who had ileal neobladder, orthotopic bladder surgeries. Urinary incontinence may occur in 20-50% of patients at night. This can be prevented by urinating at night.