Laparoscopic Surgery for Bladder Cancer

If the tumour is invasive, large or has spread to various parts of the bladder, a radical cystectomy is necessary. In other words, the whole organ must be removed.

So that the urinary tract can still work – producing, storing and eliminating urine – reconstruction surgery is necessary.

These reconstructions can be of different types:

• Creation of a new bladder made from the small intestine (ileum);
• Incontinent diversion – in which the ureters (the tubes carrying urine from the kidneys) are attached to one of the sides of a section of the intestine (also usually a section of the ileum) and the other side to the skin. The patient thus has a “stoma”, (in this case called a urostomy).
• Continent diversion – similar to the above but in which an intestinal pouch and a “valve” mechanism are created. This valve allows the patient to catheterise the pouch so that it can be emptied at regular intervals.

Radical cystectomy is accompanied by the removal of the prostate and seminal vesicles in men and the ovaries, fallopian tubes, uterus (including the neck) and a small part of the vagina in women. The lymph nodes near these organs are also removed.

This surgical procedure only removes the part of the bladder wall where the tumour is located.

One of the benefits is that the bladder is preserved. It therefore does not need later reconstruction. However, it can only be performed in very special cases due to the high risk of recurrence and evolution of the disease.

Furthermore, this change in the bladder implies a partial loss of volume and capacity to retain the same amount of urine as prior to the procedure. As a consequence, frequency of urination often increases.