Our Summary
This research paper discusses the treatment and post-surgery care for muscle-invasive bladder cancer. The current standard treatment is radical cystectomy, which is the removal of the bladder. After removal, parts of the small and large intestines can be used for urinary diversion, which is a way to allow urine to leave the body after the bladder has been removed.
The paper highlights the importance of monitoring patients after surgery, focusing on functional, metabolic and cancer-related aspects. Functional monitoring refers to checking for issues like narrowing of the urinary tract, difficulty in emptying the bladder, or incontinence.
Cancer-related monitoring involves checking for local recurrences of cancer, recurrences in the urethra and upper urinary tract, and distant metastases (spread of cancer to other parts of the body). Given that 90% of recurrences happen within the first three years, close monitoring during this period is crucial.
The paper also notes that metabolic disturbances can occur as a result of using parts of the intestines for urinary diversion. These disturbances could include vitamin B12 and bile acid deficits, acidosis (excessive acid in the body fluids), and disorders of calcium metabolism. Therefore, post-surgery care should also consider these possible metabolic consequences.
FAQs
- What is urinary diversion surgery and when is it required?
- What are the potential complications and considerations after urinary diversion surgery?
- How is post-surgery monitoring for bladder cancer patients conducted and why is it important?
Doctor’s Tip
One helpful tip a doctor might tell a patient about urinary diversion surgery is to stay hydrated and maintain a healthy diet. Drinking plenty of water can help prevent urinary tract infections and kidney stones, while a balanced diet can help minimize metabolic disturbances and promote overall health. Additionally, patients should follow up regularly with their healthcare team for monitoring and to address any concerns or complications that may arise.
Suitable For
Patients who are typically recommended for urinary diversion surgery include those with muscle-invasive bladder cancer that has not responded to other treatments, such as chemotherapy or radiation therapy. Additionally, patients with other conditions that require removal of the bladder, such as severe bladder dysfunction or chronic infection, may also be candidates for urinary diversion surgery.
It is important to note that urinary diversion surgery is a major procedure with potential risks and complications, so patients should be carefully evaluated by a multidisciplinary team of healthcare providers to determine if they are suitable candidates for the surgery. Additionally, patients should have a thorough understanding of the potential benefits and risks of the procedure before making a decision to undergo urinary diversion surgery.
Overall, patients recommended for urinary diversion surgery are those with conditions that require removal of the bladder and who have not responded to other treatments. Close monitoring and post-surgery care are essential to ensure optimal outcomes for these patients.
Timeline
Before urinary diversion surgery, a patient typically undergoes a series of diagnostic tests and consultations to determine the extent of their bladder cancer and whether surgery is the best treatment option. This may include imaging tests, biopsies, and discussions with a multidisciplinary team of healthcare providers.
After the surgery, the patient will likely spend several days in the hospital recovering. They will receive pain management, physical therapy, and education on how to care for their surgical incisions. A catheter will be placed to drain urine while the surgical site heals.
In the weeks and months following surgery, the patient will have regular follow-up appointments with their healthcare team to monitor their progress and address any complications. This may include adjustments to their urinary diversion system, if necessary, as well as ongoing monitoring for cancer recurrence and metabolic issues.
Overall, the timeline for a patient before and after urinary diversion surgery involves a thorough pre-surgical evaluation, a hospital stay for recovery, and ongoing monitoring and care to ensure the best possible outcomes for the patient’s health and quality of life.
What to Ask Your Doctor
Some questions a patient should ask their doctor about urinary diversion surgery include:
- What are the different types of urinary diversion options available, and which one would be most suitable for me?
- What are the risks and potential complications associated with urinary diversion surgery?
- What is the expected recovery time and post-surgery care plan?
- How will my quality of life be impacted after urinary diversion surgery?
- What kind of lifestyle changes will I need to make after the surgery?
- How often will I need to follow up with my doctor for monitoring and check-ups?
- What symptoms should I watch out for that may indicate complications or issues with the urinary diversion?
- Are there any specific dietary restrictions or recommendations I should follow after the surgery?
- How can I manage any potential side effects or complications that may arise post-surgery?
- What long-term effects should I be aware of after undergoing urinary diversion surgery?
Reference
Authors: Netsch C, Filmar S, Hook S, Rosenbaum C, Gross AJ, Becker B. Journal: Urologie. 2024 Oct;63(10):1050-1059. doi: 10.1007/s00120-024-02401-8. Epub 2024 Aug 1. PMID: 39088083