6 March 2019 Author : Kris Maes The bladder is a hollow, distensible organ that makes up part of the urinary system. It is attached to the kidneys by the ureters, and its function is to store the urine produced until it is eliminated to the outside of the body through the urethra. Smoking is the main risk factor for the development of bladder cancer. Other risk factors are: Exposure to certain chemical compounds; Personal or family history of bladder cancer. Most bladder cancers originate in the inner lining of this organ, which is called the urothelium . What are the main symptoms of bladder cancer? The symptoms of bladder cancer can be similar to those of other diseases, such as an infection. Therefore, a diagnosis of bladder cancer requires detailed medical evaluation and further diagnostic tests. The following symptoms, among others, can be associated with bladder cancer: Blood in the urine; Urinary urgency; Need to urinate more often than usual; Feeling that the bladder needs emptying, but without any result; The need to strain in order to empty the bladder; Pain during urination. Does bladder cancer affect men or women more? Urothelial carcinoma is the most common type of bladder tumour, accounting for about 90% of cases, both in Europe and the United States. Bladder cancer is more frequent in men than in women, at a ratio of about 3 to 1. In terms of the frequency of all forms of cancer, men are in 7th place and women are in 15th place. How is bladder cancer treated? The choice of treatment for bladder cancer depends on a number of factors, for example: Type and location of tumour; Level of invasion into the bladder wall; Surrounding tissues; Dissemination to other tissues or organs; Patient’s age; Patient’s general condition; Specific features of each case. Treatment of bladder cancer can involve: Surgery; Chemotherapy; Radiotherapy; Biological therapy. Bladder cancer surgery The treatment of choice for both the high-risk superficial disease and cancer with non-metastasised invasion of the muscular layer of the bladder is radical cystectomy (surgical removal of the bladder). While surgery may be extended to neighbouring organs, this will depend on the size of the tumour, the degree to which these structures have been invaded and the sex of the patient. Removal of pelvic lymph nodes (pelvic lymphadenectomy) is usually also performed. In men, radical cystectomy includes surgical removal of the bladder, prostate and seminal vesicles. For women , it includes surgical removal of the bladder, uterus and upper part of the vagina. What happens after the bladder is removed? Once the bladder has been removed, it is necessary to create a new site for the urine to be stored. This procedure is called urinary diversion and involves the use of a segment of the small or large intestine. Depending on the extent of the tumour and the patient's age and preferences, urinary diversion by ileal conduit or a reconstruction of the ileal bladder (pouch) may be performed. This works as follows: The urine is directed through a channel, made with the segment of the intestine, to an opening created on the surface of the skin, which is known as a stoma . Afterwards, a bag for storing urine is applied to the stoma, and the patient empties this when necessary; The intestine segment is used to create a reservoir under the skin. Urine is stored in this reservoir, which is emptied with a catheter (thin tube). In this case, it is not necessary for the patient to use an external bag to store the urine; A new bladder is created from the segment of intestine, which is connected to the urethra and allows the patient to urinate normally. The role of robotics in bladder cancer surgery Typically, bladder cancer surgery is carried out by open surgery. However, in many cases, robot-assisted laparoscopy is being used. These days, many centres throughout Europe carry out the entire procedure without the need for a large incision. In minimally invasive radical cystectomy (whether or not assisted by robotic surgery), the objective is to obtain oncological results similar to those obtained with open surgery. Potential post-operative complications and the recovery period are therefore reduced. The interest of urologists with experience in robotic surgery in robot-assisted laparoscopic cystectomy has increased over the last few years. Three-dimensional visualisation and instruments with intracorporeal articulation make it possible to significantly reduce the complexity of the fully laparoscopic procedure, with resulting advantages for patients. Meet the urology team from Hospital da Luz network and book your consultation The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
