Three-quarters of bladder cancer patients have superficial or early cancer when they are first diagnosed. Local surgery in the bladder with a cystoscope is usually their first treatment.
Transurethral Surgery (TUR)
TUR is performed using a cystoscope, the same instrument used for diagnosis, consisting of a tube with a camera chip and a light inserted through the urethra into the bladder. This scope has a wire loop at the end to remove suspicious tissue and tumors. Surgeons may also use lasers and other devices to destroy the base of the tumor (a procedure called fulguration). Since bladder cancer tends to recur, surgeons at Columbia University Department of Urology follow bladder cancer patients closely and are pioneering numerous new treatments to prevent recurrence and progression.
This operation is used to treat more invasive bladder cancers. A partial cystectomy is performed when cancer has invaded just one part of the bladder wall for individuals who are unlikely to tolerate a complete cystectomy . A radical cystectomy is performed when the cancer has spread farther throughout the bladder. In a radical cystectomy surgeons remove the bladder, nearby lymph nodes, part of the urethra, and nearby organs that may contain cancer cells. In men they may also remove the prostate, seminal vesicles, and part of the vas deferens. Women undergoing radical cystectomy may have the cervix, uterus, ovaries, fallopian tubes, and a very small part of the vagina removed.
Whenever possible, Columbia Urology experts perform cystectomies using minimally invasive robotic laparoscopy. Surgeons control robotic arms that hold miniaturized instruments. This approach only requires a few small incisions in the abdomen, leading to a faster recovery time.
Reconstructive Bladder Surgery (Neobladder)
If the entire bladder must be removed, reconstructive surgery can create an alternative way to store and eliminate urine. Columbia Urology has been at the forefront in reconstructive techniques for patients after radical cystectomy. Our surgeons create a new bladder (neobladder) in appropriate patients, using a portion of the small intestine. This is attached to the urethra, allowing both men and women to urinate in a more normal manner after bladder removal. Complication rates for neobladder creation at Columbia Urology are among the lowest reported in the nation.
If our surgeons cannot create a neobladder they create an internal bladder connected to an opening in the abdomen. Patients can drain this reservoir several times a day using a catheter. Another alternative is an ileal conduit allowing the urine to pass through a passage in the small intestine. This drains continuously through an external bag. This procedure has a low rate of complication and a high rate of patient satisfaction.
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