Medical Q&As

Bladder cancer - radical surgery needed?

My husband has been diagnosed with cancer of the bladder and his doctor has recommended removal of the bladder and prostate (although the tumour is only inside the bladder). Is there any real alternative to the bag? Can the bladder be reconstructed successfully? Appreciate if you could reply urgently as he's just been diagnosed and surgery is planned for this week.

The procedure you refer to is called a radical cystectomy and this involves removal of the bladder, prostate gland, lymph nodes and seminal vesicles. This radical procedure is performed when bladder cancer has invaded the muscle layer within the bladder or when a superficial cancer has covered a large part of the bladder wall. There are a number of surgical procedures available that involve connecting the ureters (tubes that carry urine from the kidneys to the bladder) to a segment of bowel that has been re-fashioned as an alternative bladder. However, these diversion techniques require that the man catheterise himself intermittently to empty urine from the re-fashioned segment of bowel. This segment of bowel is technically referred to as a neo-bladder. The objective in performing this type of diversion technique is to preserve some degree of urinary continence. These techniques are contraindicated if the man has a history of bowel disease such as Crohnís disease, ulcerative colitis or even severe irritable bowel disease. They are also contraindicated in the case of elderly people or those with poor hand coordination. If renal function is poor that also renders a person unsuitable for the procedure. These procedures require a high degree of motivation and compliance and are not suitable for every case of radical cystectomy. There may also be specific considerations in your husbandís case that dictate that he be given a urostomy. This procedure is in some ways comparable to a colostomy except that in this case it is urine that drains into the bag and not bowel contents. Urostomy bags are continually being improved and refined and it is standard practice for people with urostomies to be under the continuing care of a specialist nurse who can provide ongoing support, care and advice regarding the various appliances that are available. You should discuss this matter further with the team that is currently looking after your husband.