The examination is not painful when carried out under local or general anesthesia. Therefore, the diagnosis of bladder cancer most often arises after cystoscopy and visual recognition of the characteristic image of exophytic tumor. Urine cytology significantly contributes to the diagnosis since cancer cells are detected in the urine. The final diagnosis is set by the histological examination of biopsy samples taken from the tumor. A biopsy will also determine the aggressiveness of the tumor and the extent of bladder wall involvement. It is worth noting that for small lesions with low aggressiveness, the resection of the tumor for the performance of biopsy is adequate treatment.
- TRANSURETHRAL RESECTION
- LAPAROSCOPIC RADICAL CYSTECTOMY
Superficial bladder tumors are treated with transurethral resection. But it is worth noting the high rate of recurrence with over 80% of cases expected to have at least one recurrence after initial treatment. The periodically repeating cystoscopy with ablation is often sufficient in low-grade tumors. Alternative means such as repeated injections of chemotherapeutic agents into the bladder are necessary to address intermediate grade tumors. The injections significantly reduce the recurrence rates and the incidence of tumor progression to more aggressive neoplasm. In case of tumors extending to muscular layer or across the bladder wall, transurethral resection is not indicated. These patients are candidates for radical cystectomy if there is no evidence of distant metastasis. Systemic chemotherapy and local radiation therapy are also management options but are usually limited to the patients that are not fit or are not willing to undergo radical cystectomy.
Radical cystectomy is considered to be one of the most demanding urologic procedures. It can be performed by open or laparoscopical approach. Despite the higher technical challenge of laparoscopic cystectomy in comparison to open surgery, the laparoscopic approach is associated with less perioperative morbidity and faster recovery. The surgery involves the complete removal of the bladder along with fatty tissue around the bladder and lymph nodes. In addition, the prostate and seminal vesicles are removed in male patients while the uterus, fallopian tubes, ovaries as well as the anterior vaginal wall are removed in the female patients. An appropriate procedure to restore the urinary tract is concomitantly performed in order to restore the urinary tract. There several different techniques to restore the urinary tract such as the drainage of urine into a small segment of bowel which releases its content to a urostomy bag attached on the abdominal wall (ileostomy), the construction of a pouch by bowel which is used as artificial bladder (continent pouch).
- PROGNOSIS AFTER CYSTECTOMY
- POSTOPERATIVE COURSE AFTER LAPAROSCOPIC CYSTECTOMY