Types Of Surgical Techniques
- Endoscopic surgery: A thin, flexible tube equipped with a camera and surgical tools is inserted into a natural opening so no incision is made in the skin.
- Keyhole surgery: This minimally invasive procedure involves several small incisions in the skin to access the bladder, and the cancer is removed through these holes using special instruments.
- Robotic surgery: Similar to keyhole surgery, robotic surgery differs in that the actual surgery is done via mechanized instruments instead of a surgeon’s hands controlling the instruments.
- Open surgery: With an open approach, a traditional large incision is made in the abdomen to access the bladder.
What To Expect After Surgery
Urethral sling surgery can be safely performed in an outpatient surgery center. There is normally a 2-4 week recovery period, during which you should avoid doing too much activity to allow your body to properly heal.
Its likely you will feel some pain and discomfort where your incision is and you may feel some cramping in your abdomen. Your doctor will prescribe you medication to help with the pain during the first few days after surgery. If you continue to experience pain, be sure to contact your doctor immediately.
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Bladder Cancer Clinical Trials
Major drug companies continually research and develop new medications and treatments for bladder cancer that must be shown to be safe and effective before doctors can prescribe them to patients. Through clinical trials, researchers test the effects of new drugs on a group of volunteers who have bladder cancer. Following a strict protocol and using carefully controlled conditions, researchers evaluate the investigational drugs under development and measure the ability of the new drug to treat bladder cancer, its safety, and any possible side effects.
Some patients are reluctant to take part in clinical trials for fear of getting no treatment at all. But patients who participate in clinical trials receive the most effective therapy currently available for the condition, or they may receive treatments that are being evaluated for future use. These bladder cancer drugs may be even more effective than current treatment. Comparing them in a clinical trial is the only way to find out.
Hereâs where to find information about whether a bladder cancer clinical trial is right for you.
This website lists industry-sponsored clinical trials that are actively recruiting patients.
American Cancer Society: âBladder Cancer Treatment,â âBladder Cancer Surgery,â âRadiation Therapy for Bladder Cancer,â âChemotherapy for bladder cancer,â âFDA Approves New Immunotherapy Drug for Bladder Cancer,â âImmunotherapy for bladder cancer.â
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What Happens During And After Surgery For A Cystocele
A moderate or severe cystocele may require reconstructive surgery to move the bladder into a normal position. There are a number of ways to perform this surgery, including an anterior repair. In an anterior repair, an incision is made in the wall of the vagina and the tissue that separates the bladder from the vagina is tightened. Another option, for more severe prolapse, is to place a synthetic material with a robotic or laparoscopic approach through the abdomen. This method may give more support to the tissue and help prevent the condition from happening again.
The patient usually goes home the day of the surgery. Complete recovery typically takes four to six weeks.
For women who never plan on having sexual intercourse again, surgeries that sew the vagina shut and shorten it so it no longer bulges are nearly 100 percent effective.
Living Without A Gallbladder
You can live a long and healthy life without a gallbladder, and to help ensure that goal, here are a few tips to consider.
Its common to experience some persistent discomfort after gallbladder removal. To help minimize that possibility, pay close attention to your diet. Gallbladder problems typically develop because of problems with the liver. According to Sandra MacRae, MD , one reason people develop gallbladder stones and other gallbladder problems in the first place is that their liver is unhealthy.
A compromised liver can produce poor quality bile, which in turn may have had a role in forming gallstones and can still interfere with liver function long after the gallbladder is gone. Therefore, she recommends the following tips once your gallbladder has been removed:
- Significantly reduce or eliminate use of grains and dairy foods. These foods are challenging to digest and the grains especially may increase the risk of developing fatty liver.
- Eat bitter foods. Foods such as dandelion greens, arugula, lemons, chicory, and endive improve digestion and assist the body in processing healthy fats.
- Take vitamin D. A vitamin D deficiency is not uncommon, especially among people who have a compromised liver since this is the organ that helps manufacture the vitamin in the body. Talk to your doctor about the proper dosage for your needs.
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What Is A Cystocele Repair
Cystocele repair is a surgery to lift and tighten the prolapsed tissue of the urinary bladder so that it doesnt fall back against the vagina.
Cystocele or prolapsed bladder is a condition where the bladder drops down in the vagina. The tissues holding the pelvic organs in place may stretch or weaken, leading to its sagging.
There are three grades of cystocele:
- Grade 1 : The bladder drops only a short way into the vagina.
- Grade 2 : The bladder drops into the opening of the vagina.
- Grade 3 : The bladder bulges through the opening of the vagina.
Factors that are likely to cause cystocele include:
- Vaginal delivery
- Frequent straining during bowel movements
Your Eating Habits May Change
Digestive changes are common, especially in the first few weeks after surgery as your body adapts to the lack of a gallbladder. At first, you may experience some bloating, gas, diarrhea, and abdominal discomfort after eating. These symptoms can be eased by cutting back on your intake of:
- Fatty foods
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What Are The Drains Needed For
To provide drainage of urine from your kidneys to the urinary diversion, you will have two temporary stents that will be visible on the outside of your body. With a neo-bladder or continent diversion, you will also have 1 to 2 catheters to drain the bladder until it heals. With an ileal conduit, you will have only an appliance over the stoma. All patients will usually also have a temporary drain connected to a bulb to collect extra fluid. This is usually removed before discharge.
Again, since the urinary diversion is constructed from the intestine, the presence of mucus in the urine is normal following this surgery. The mucus will decrease over a period of time. This is especially important for neo-bladders and continent diversions. Immediately after surgery, to prevent the catheters from becoming plugged, it is important that they be regularly flushed with sterile water. You will be given supplies and taught how to irrigate these catheters.
The stents and catheters may stay in place up to 2 to 4 weeks to allow adequate time to heal. The surgeon will let you know when they will be removed.
What Are The Types Of Urinary Diversions
Once the bladder is separated from the ureters and urethra, it is necessary to provide another way to collect and drain the urine. Several options exist and depend on the overall health of the patient, the extent of cancer, and an individualâs motivation and active participation in their care.
In selected patients, a portion of the intestines is used to create a new bladder or neo-bladder . The ureters are joined to one end of the neo-bladder and the other end is connected to the remaining portion of the urethra. The new bladder is constructed in such a way that it will provide a reservoir to store urine and control urine flow. You may urinate in much the same way you do now.
For patients who receive the neo-bladder, you will notice that you will not be able to hold any urine in the neo-bladder initially. This is temporary. Please buy incontinence pads or pull-ups for the first few weeks to months after the surgery. Most patients will gain control of their urine within a few months.
NeobladderContinent DiversionIleal Conduit
However, at the time of surgery if your urethra is involved with cancer, it will need to be removed and some patients may benefit from creating a continent diversion, where one end of the new bladder will be brought out to the side of the abdomen to create a stoma without the use of an appliance bag. A small catheter is then passed through the stoma to drain out the urine and empty the new bladder 4 to 6 times a day.
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What Happens Before The Operation
You will be admitted to the hospital the day of your operation. The anesthesiology team will talk to you about their portion of the surgery. If you are a candidate, you may receive an epidural, which is a good option to manage post-surgery pain. The usual hospital stay is 6 to 8 days. On the day of surgery, your family can wait for you in the surgical waiting area on the first floor of the Ronald Reagan Hospital . It usually takes 4 to 8 hours to complete this operation. On completion of the operation the surgeon will contact your family there.
A portion of your intestines will be used to create the urinary diversion. It is important that the entire intestine be clean before surgery, and that you prepare your gastrointestinal tract prior to admission to the hospital. Your surgeon will provide you specific instructions for the bowel preparation.
How To Prepare For Transurethral Resection
Before your surgery, your physician will ask that you end your medications that are used as blood-thinners. You will likely be given an antibiotic to prevent a urinary tract infection after the surgery. Typically, you are able to go home after the surgery, so you will need someone to drive you home. You should not work or do any strenuous activity for up to six weeks after the surgery. Your physician will be able to give you a better expectation of how much recovery time you will need.
The procedure will take between sixty to ninety minutes. You will be given general anesthesia. This means that you will be asleep for the duration of the surgery. If your physician recommends a spinal anesthesia, then you will be awake but not feel anything.
During the procedure, your physician will insert a resectoscope into the top of the penis and will be extended through the urethra. There will be no incisions on the body. The resectoscope will be used to trim the tissue from in the prostate. When these pieces are cut, an irrigating fluid will carry them into the bladder. They will be removed.
After surgery, your physician will likely recommend the following:
- Avoid taking your blood-thinning medications until your physician says otherwise
- Drink a lot of water to flush out the bladder
- Eat high fiber foods as you will not want to strain during a bowel movement
- Avoid strenuous activities
- Do not drive until your catheter has been removed
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When Should You Call For Help
anytime you think you may need emergency care. For example, call if:
- You passed out .
- You have chest pain, are short of breath, or cough up blood.
or seek immediate medical care if:
- You have bright red vaginal bleeding that soaks one or more pads in an hour, or you have large clots.
- You are sick to your stomach or cannot drink fluids.
- You have pain that does not get better after you take pain medicine.
- You have loose stitches, or your incisions come open.
- Bright red blood has soaked through the bandages over your incisions.
- You have vaginal discharge that has increased in amount or smells bad.
- You have signs of infection, such as:
- Increased pain, swelling, warmth, or redness.
- Red streaks leading from the incision.
- Pus draining from the incision.
- A fever.
Watch closely for changes in your health, and be sure to contact your doctor if you have any problems.
What Are The Different Types Of Sling Surgery
The two most common types of bladder slings are midurethral and traditional.Midurethral: This sling is inserted during an outpatient procedure that only takes about 30 minutes. Typically, a strip of synthetic mesh is inserted through a single incision in your vagina, and cradles the urethra like a hammock. The procedure may also involve a retropubic method in which two additional incisions are made near the pubic bone to secure the mesh. The transobturator method is another midurethral option in which small incisions are made in the vagina and the labia to secure your sling.Traditional: A traditional, or conventional, bladder sling is inserted during an inpatient procedure, which means you will likely spend a night in the hospital afterward. Traditional bladder sling surgery may use synthetic mesh, or tissue from your own body . With this method, one incision is made in your vagina and one in your belly, in order to connect the sling using tension under the bladder neck. Conventional bladder sling recovery can take longer and may involve more complications.
Sex Life And Fertility
Men might not be able to get an erection after surgery. The nerves that control erections can be damaged during the operation. Sometimes your surgeon might be able to preserve these nerves so you can still get an erection.
After having your prostate gland removed during surgery, you can no longer father a child. Even if you can get an erection, you cannot ejaculate as you did before.
Women might have to have their vagina shortened when their bladder is removed. Your surgeon tries to avoid this as far as possible. You might also have your womb removed during surgery. This means you cant have children.
Everyone Is A Little Different
Know that surgery and recovery are a different experience for everyone. And there is a range of experiences that are normal. Women that have medical diagnoses such as fibromyalgia or a history of trauma frequently have more pain after surgery. And recovery, even after a small procedure like a sling surgery, is always impacted by your social support. Women with a good social support system always have an easier road after surgery. Trying to manage your daily life- family, kids and work- on top of recovering from surgery is a daunting task.
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What To Expect After Your Surgery
As you can see, radical cystectomy is very major surgery and youll have a lengthy recovery. Many parts of the body are affected during the surgery and need time to heal.
On average, your hospital stay will be 5 to 10 days. Walking starts the day after surgery. This helps the bowels to start working again. Remember, this is bowel surgery too, not just bladder surgery! Expect to be on a liquid diet for the first few days before solid foods are gradually introduced.
While in hospital, youll have a number of IV lines and tubes, depending on your type of surgery. These will provide pain control, urine drainage and drainage of excess fluid from the surgical site.
When Should I Contact My Usual Healthcare Provider
Contact your healthcare provider if you have symptoms of any of the conditions that require bladder surgery to treat. Bladder cancer symptoms you should report include:
- Hematuria . This is the most common symptom of bladder cancer. Your urine may look red, or it could look pink or dark brown.
- An urgent need to pee.
- Frequent urination.
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Should I Be Careful With What I Eat Or Drink With A Urostomy
Go easy on beverages near bedtime, and attach a larger night drainage bag to hold more urine while you sleep.
Your pouch is odor-proof, so you wonât smell anything until you empty it. If your pee has a very strong odor, it could be a sign of an infection. But other things can affect the smell, too:
- Foods, like asparagus, coffee, fish, garlic, and onions
- Medicines, such as antibiotics
- Supplements, like vitamins
Basic Skin Care With A Urostomy
- Be gentle when you remove the pouch.
- Change your pouch as often as your nurse tells you to. Doing it too often or not enough can cause skin problems.
- Donât use more tape than you need.
- Make sure your pouch fits your bodyâs shape.
- Measure your stoma carefully so you can cut your pouchâs skin barrier to fit closely.
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Sexual Effects Of Urostomy
Its normal people to be concerned about having a sex life with a urostomy. Having your ostomy pouch fit correctly and emptying it before sex reduces the chances of a major leak. A pouch cover or small ostomy pouch can be worn with a sash to keep the pouch out of the way. Wearing a snug fitting shirt may be more comfortable. Choose sexual positions that keep your partners weight from rubbing against the pouch. For more tips, see Urostomy Guide.