The main treatment for muscle-invasive bladder cancer is surgical removal of the urinary bladder. In invasive bladder cancer, there are several reasons for recommending removal of the entire bladder: Presence of muscle-invasive tumor, presence of multiple cancer foci, aggressively growing (high grade) or superficial tumor that recurs after chemotherapy or immunotherapy, a bladder-sparing approach (chemoradiation) Radical cystectomy is a condition that requires radical cystectomy if there is a failure or recurrence after a period of time, or serious side effects, and symptoms such as bleeding or pain in patients whose definitive treatment is not possible. Factors such as biological age (the body's performance with aging, measured as performance status or life expectancy) and the patient's other diseases (diabetes, heart disease, high blood pressure) are also factors to be considered for radical cystectomy. Patients over the age of 80 have more problems in the recovery process after such an operation. It uses special indexed scores to assess the risk of patients undergoing this stressful operation. Prior abdominal surgery or radiotherapy complicates surgery, but is rarely a reason for inoperability. Being overweight does not affect survival after surgery, but does affect the risk of complications from wound healing.
The removal of the bladder is done through an incision (open) in the abdomen to the patient under general anesthesia. The bladder, proximal ends of the ureters to the bladder, pelvic lymph nodes, and (part of) adjacent sex-specific organs are removed. After that, another route must be established to store and drain urine (urinary diversion).
1-Ileal loop (Briker surgery):
A small gap between the ureters and the skin insertion of a piece of intestine (ileal canal) An ileal canal can be created by placing a piece of small intestine between the ureters and the skin. This 'enteric stoma' creates greater distance between the kidneys and the skin, reducing the risk of infection that usually enters the body from the outside. Another advantage for patients is that this stoma is easier to manage and less narrowing (stenosis) than smaller stomas. Repeat In addition to side infections, long-term complications such as narrowing of the mouth/scarring (stenosis), leakage and urinary stone formation (urolithiasis) may occur.
2-ARTIFICIAL BLADDER-New Bladder- Intestinal Bladder
Creation of an artificial bladder from the intestine (orthotopic artificial bladder): In this technique, a new bladder can be made from the small intestine separated from the digestive system. A reservoir (neobladder) formed from the small intestine is placed in the pelvis to replace the bladder. Depending on the technique used, this reservoir is either round or "W" or "V" shaped. The ureters are attached on both sides and the lower end is attached to the urethra. The urinary sphincter is preserved. With this technique, a continent reservoir is made that holds a volume comparable to that of a healthy human bladder.
With an orthotopic neobladder, urine should be emptied every 2-4 hours because the bladder is full or you will not feel the need to urinate. The neobladder is emptied by contraction of the abdominal muscles and relaxation of the pelvic floor muscles (Valsalva maneuver). Pressing on the abdomen with both hands helps to completely empty the neobladder. Intermittent catheterization is needed for complete drainage in 20% of women, but not usually in men. This diversion requires you to have a good understanding of the requirements of the procedure in order to be compatible with them. For this diversion; Acceptable liver and kidney functions, relatively long life expectancy, good mental status, functional pelvic floor (previous incontinence) are required. This technique is not suitable in case of extensive previous surgical operation or radiotherapy.
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Short-term complications include recurrent infections (including inflammation of the abdominal wall and kidneys) and urinary leakage; long-term complications include narrowing of the mouth of the neobladder, changes in the upper urinary system, urinary incontinence, short bowel syndrome, hernia, metabolic and electrolyte imbalance Close follow-up and guidance are important in the first months of this urinary diversion. Health care team is important in adjusting to the new situation. It is important to change lifestyle and get used to daily routines (urinating on a fixed schedule). is from. Routine blood testing will help assess whether the absorption of too much uric acid by the used gut is causing pH imbalances that usually require treatment with oral medications (sodium bicarbonate = baking soda). The newly created reservoir needs time to settle and start working. You will need to train your bladder to increase its capacity and the healthcare team should provide bladder training to the patient. Exercise is required to increase the capacity of the neobladder (bladder exercise). Initial urinary incontinence may occur due to post-operative swelling near the pelvic floor and/or initially due to a predominant lack of the neobladder.
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