Our Summary

This research paper looks at a surgical procedure called Robot-Assisted Radical Cystectomy (RARC) with intracorporeal diversion, which is a type of surgery for bladder cancer. The paper examines four main types of this surgery, specifically focusing on the creation of a new bladder within the body, known as a neobladder.

The authors review the results from various studies on this procedure and compare different aspects such as how well the surgery works, how patients recover after surgery, and how the new bladder functions. They found that in some cases, RARC with a totally intracorporeal neobladder can improve surgical outcomes, recovery and bladder function, making it a safe and viable alternative to traditional open surgery.

However, they conclude that while the results seem promising, more high-quality, randomized controlled trials are needed in order to fully understand the pros and cons of this procedure and its potential role in treating invasive bladder cancer in the future.

FAQs

  1. What is Robot-Assisted Radical Cystectomy (RARC) with intracorporeal diversion?
  2. How does the creation of a neobladder improve surgical outcomes and patient recovery?
  3. Why are more high-quality, randomized controlled trials needed for this surgical procedure?

Doctor’s Tip

One helpful tip a doctor might tell a patient about urinary diversion surgery is to follow all post-operative care instructions closely, including proper wound care, diet modifications, and activity restrictions. It is important to attend all follow-up appointments and communicate any concerns or changes in symptoms to your healthcare provider promptly. Additionally, maintaining a healthy lifestyle, including staying hydrated, eating a balanced diet, and engaging in regular exercise, can help promote healing and overall well-being after surgery.

Suitable For

Patients who are typically recommended for urinary diversion surgery include those with bladder cancer, specifically invasive bladder cancer that has not responded well to other treatments such as chemotherapy or radiation therapy. Additionally, patients with other conditions such as neurogenic bladder, interstitial cystitis, or severe urinary incontinence may also be candidates for urinary diversion surgery.

Patients who have undergone a cystectomy, or removal of the bladder, may require urinary diversion surgery in order to create a new way for urine to leave the body. This can be done by creating a stoma, or opening in the abdomen, for urine to pass through, or by creating a new bladder within the body known as a neobladder. Patients who are unable to undergo traditional open surgery due to medical reasons or who prefer a less invasive approach may also be recommended for urinary diversion surgery.

Overall, patients who are recommended for urinary diversion surgery are those who have a significant need for a new way to store and eliminate urine, either due to bladder cancer or other medical conditions affecting the bladder. The decision to undergo urinary diversion surgery should be made in consultation with a healthcare provider who can assess the individual patient’s medical history, condition, and treatment goals.

Timeline

Before urinary diversion surgery:

  1. Diagnosis of bladder cancer: The patient may experience symptoms such as blood in the urine, frequent urination, or pain during urination, leading to a diagnosis of bladder cancer.
  2. Treatment discussions: The patient will meet with their healthcare team to discuss treatment options, including the possibility of urinary diversion surgery.
  3. Pre-surgical preparations: The patient will undergo pre-operative tests and assessments to ensure they are healthy enough for surgery.
  4. Surgery: The patient will undergo robot-assisted radical cystectomy with intracorporeal diversion, where the bladder is removed and a new bladder is created within the body.
  5. Recovery: The patient will stay in the hospital for a period of time to recover from surgery, which may involve pain management, physical therapy, and learning how to care for their new bladder.

After urinary diversion surgery:

  1. Post-operative care: The patient will receive instructions on how to care for their surgical incisions, manage pain, and prevent complications.
  2. Rehabilitation: The patient may undergo physical therapy to regain strength and function after surgery.
  3. Follow-up appointments: The patient will have regular follow-up appointments with their healthcare team to monitor their recovery and the function of their new bladder.
  4. Adjustment period: The patient may need time to adjust to life with a new bladder, including learning how to manage their urinary function and any changes in their daily routine.
  5. Long-term monitoring: The patient will need regular monitoring and surveillance to check for any signs of cancer recurrence and ensure the continued health of their new bladder.

What to Ask Your Doctor

  1. What are the different types of urinary diversion surgeries available and which one do you recommend for me?
  2. What are the potential risks and complications associated with urinary diversion surgery?
  3. How long is the recovery period after surgery and what can I expect during the recovery process?
  4. Will I need to make any lifestyle changes or dietary modifications after the surgery?
  5. How will the surgery affect my urinary function and what can I do to manage any changes in my bladder habits?
  6. What is the success rate of this surgery in terms of treating bladder cancer and improving quality of life?
  7. Are there any long-term side effects or complications that I should be aware of?
  8. Will I need any additional treatments or follow-up care after the surgery?
  9. How experienced are you in performing urinary diversion surgeries, and what is your success rate with this procedure?
  10. Are there any alternative treatment options available that I should consider before deciding on urinary diversion surgery?

Reference

Authors: Gaston R, Ramírez P. Journal: Arch Esp Urol. 2019 Apr;72(3):309-317. PMID: 30945658