“There are no perfect guidelines for how quickly surgery should be done after diagnosis of bladder cancer,” says Dana Rice, MD, a board certified urologist and creator of the UTI Tracker mobile app, which helps patients catalogue daily urinary tract symptoms, medication and behavioral patterns, and offers personalized tips for UTI prevention.
“The staging and grade of bladder cancer is more indicative to how fast or slow it may advance,” continues Dr. Rice.
“However, this is not known until there is specimen to examine. I usually tell my patients that ‘cancer doesn’t grow overnight usually. If you have your daughter’s wedding in a few weeks, go dance and come back to me for surgery. If you choose to wait more than a few weeks, that is always your choice, but I don’t recommend it.’
“The exception to this rule would be patients who are very old or sick for which anesthesia risks outweigh the benefit of surgical diagnosis. As you can imagine, those are much harder conversations.”
Initial Surgery and a
Second Surgery for Treatment
Dr. Rice explains, “The initial surgery is a TURBT (transurethral resection of bladder tumor) and +\- random bladder biopsies to look for CIS (carcinoma in situ) which you can’t see with the naked eye.
“If the tumor is non-invasive this may be the only surgery that is needed. If it is questionable how deep it goes or if there is no muscle in the sample, there may need to be a second TURBT.
“If it is invasive into muscle or for some people high grade and recurrent, then we discus the need for cystectomy (bladder removal).”
Bladder removal brings to mind lifelong dependency on an external tube and bag that collects urine.
“Although a cystectomy is a daunting procedure, there are alternatives to having bags and tubes draining,” says Dr. Rice.
“In certain candidates, a neobladder that allow urination similar to a regular bladder is possible by reconstructing intestine to hold urine.”
This would be a new urinary tract fashioned from a portion of the patient’s intestine. The neobladder functions like a normal urinary tract.
Dr. Rice points out that there is a greater-than-40-percent complication rate with cystectomies, and that “many people aren’t eligible for an orthopedic neobladder (regular peeing diversion).”
Dr. Rice is with Inova Medical Group in Fairfax, VA, and her clinical interests include bladder, kidney and prostate cancer, minimally invasive surgery and robotic surgery.