Our Summary

This research paper is about a medical procedure known as orthotopic neobladder, which is a treatment option for women with bladder cancer that involves creating a new bladder from a piece of the patient’s intestine. The study finds that this treatment has very good cancer control outcomes and a low chance of the cancer coming back in the urethra. However, choosing the right patient for this procedure is crucial. It’s also important for the patient and her family to fully understand what to expect from this treatment. The skill of the surgeon is also key in achieving the best possible results in terms of maintaining urinary control, sexual function, and minimizing complications such as fistulas (abnormal connections between the vagina and urinary tract) and urinary retention (inability to completely empty the bladder).

FAQs

  1. What is an orthotopic neobladder and when is it used in surgery?
  2. What factors are considered in patient selection for orthotopic urinary diversion?
  3. What are the potential functional outcomes of an orthotopic diversion surgery?

Doctor’s Tip

One helpful tip a doctor might tell a patient about urinary diversion surgery is to carefully follow all post-operative instructions provided by the medical team, including proper care of the surgical site, monitoring for any signs of infection or complications, and adhering to any dietary or lifestyle changes recommended for optimal recovery and function of the urinary diversion. It is also important for patients to communicate any concerns or symptoms they may experience with their healthcare provider promptly.

Suitable For

Patients who may be recommended for urinary diversion surgery include those with bladder cancer, neurogenic bladder dysfunction, interstitial cystitis, refractory urinary incontinence, and other conditions that require the removal of the bladder or a diversion of urine flow. In particular, women undergoing cystectomy for bladder cancer may be suitable candidates for orthotopic neobladder reconstruction, as mentioned in the abstract above. It is essential for patients to be carefully evaluated by a urologist to determine the most appropriate type of urinary diversion surgery for their specific condition and individual needs.

Timeline

Before urinary diversion surgery:

  1. Diagnosis of bladder cancer and discussion of treatment options, including urinary diversion surgery
  2. Consultation with a urologist and/or surgeon to discuss the procedure, risks, benefits, and potential outcomes
  3. Preoperative testing and preparation for surgery, including imaging studies, blood work, and possibly a bowel preparation
  4. Education about the surgery, recovery process, and potential complications
  5. Consent for surgery and anesthesia

After urinary diversion surgery:

  1. Recovery in the hospital for several days to monitor for any complications
  2. Gradual return to normal activities, including walking, eating, and drinking
  3. Learning how to care for the surgical incision and any drains or catheters
  4. Follow-up appointments with the surgeon to monitor healing and address any concerns
  5. Rehabilitation and physical therapy to improve bladder control and pelvic floor function
  6. Adjustment to the new urinary diversion, including learning how to empty it and manage any potential complications
  7. Long-term follow-up to monitor for any signs of cancer recurrence and to address any ongoing issues related to the urinary diversion.

What to Ask Your Doctor

Some questions a patient should ask their doctor about urinary diversion surgery may include:

  1. What are the different types of urinary diversion surgeries available?
  2. What are the risks and potential complications associated with urinary diversion surgery?
  3. How long is the recovery process and what can I expect during the recovery period?
  4. Will I need to make any lifestyle changes or modifications after the surgery?
  5. How will the surgery affect my bladder function, urinary continence, and sexual function?
  6. What follow-up care will be required after the surgery?
  7. What is the success rate of this surgery and what are the long-term outcomes?
  8. Are there any alternative treatment options to consider before proceeding with urinary diversion surgery?
  9. How experienced is the surgical team in performing this type of surgery?
  10. What support resources are available for patients undergoing urinary diversion surgery, such as support groups or counseling services?

Reference

Authors: Zlatev DV, Skinner EC. Journal: Urol Clin North Am. 2018 Feb;45(1):49-54. doi: 10.1016/j.ucl.2017.09.005. PMID: 29169450