Bladder resection is a surgical operation that involves the removal of part of an organ. This type of intervention can be performed both in men and in women. Often, surgery is prescribed for malignant tumors of the bladder and for multiple protrusions of the mucous membrane (diverticulosis). The rehabilitation period after the operation is often associated with various complications, therefore, such patients are prescribed a special diet and medical treatment.
What can be a resection
The bladder is a hollow organ that is located in the pelvis and acts as a natural reservoir for the accumulation and excretion of urine from the body. Pathologies of this organ are diagnosed in every fifth urological patient in need of surgical intervention.
Since the main indication for surgery is a cancer of the bladder, resection is the only suitable treatment option. Patients at the stage of metastasis and the formation of diverticulum do not help any conservative methods.
Intervention is by open or transurethral access. Today, surgeons perform the following types of operations on the bladder:
- Partial cystectomy, implying open access to the organ.
- TUR - transurethral resection of the bladder.
- Endoscopic laser removal of the affected part of the organ.
Bladder resection can be recommended for other diseases that are accompanied by urinary retention and are not amenable to drug therapy, in particular for organ trauma, the formation of polyps, stones, fistulas, ulcerative cystitis, endometriosis.
Diagnosis before surgery
Before starting surgery, the patient is prescribed an examination. Diagnosis will help determine the exact location of the affected area of the organ, the size of the tumor and its structure. For this purpose, carry out:
- Ultrasound of the pelvic organs. This is one of the simplest and most affordable types of examination, which allows you to get an objective idea of the disease. In addition to the usual abdominal ultrasound, transurethral or transvaginal can be performed.
- Cystoscopy is an endoscopic examination procedure, which involves the introduction of a cystoscope through the urethra into the organ cavity. The device makes it possible to survey the surface of the mucous membrane and to take a tissue sample for histological examination of the existing neoplasm.
- Urinalysis for atypical cells.
- Urocystography with a contrast agent.
- CT scan. This type of diagnosis is prescribed after the detection of a tumor in order to clarify its size, exact location, condition of nearby organs and lymph nodes.
- Intravenous urography of the urinary tract allows you to evaluate the patency of the urinary tract.
Cancer can be confirmed by biopsy. The patient's prognosis will depend on the type of education. Even after a successful resection, the patient remains registered with the oncologist, since the likelihood of relapse is not ruled out. When confirming a malignant neoplasm, patients should also have a CT scan of all abdominal organs to determine if metastases are removed.
Not always patients have to go through all kinds of studies. A set of diagnostic procedures is prescribed individually for each patient. Immediately before conducting a bladder resection, as well as before any other surgical operation, general clinical and biochemical tests are prescribed, and blood groups and Rh factor must be determined. In addition, before the intervention, the patient must undergo a test for the presence of antibodies to HIV infection, syphilis, hepatitis, undergo examination by narrow specialists and the therapist in the presence of concomitant chronic diseases.
If an inflammatory process occurs in the bladder, a resection cannot be performed. In this case, the patient is prescribed an analysis for bacteriological culture of urine and treatment with antibacterial drugs. Regardless of the type of surgery, drinking and eating should be discarded several hours before it.
Open abdominal surgery
With partial cystectomy, an abdominal wall is incised. Depending on the location of the pathology, the place of penetration of medical instruments is determined. If the tumor is located on the posterior wall of the organ, the peritoneum is opened and a median laparotomy is performed . In the case of the anterolateral presence of the formation, the surgeon makes an arched incision, gaining access through the suprapubic region. Tissues are dissected in layers after excretion of the bladder into the wound. After opening the wall, the surgeon performs a resection of the tumor of the bladder.
To date, this surgical technique is significantly inferior in popularity to transurethral. An open abdominal operation on the bladder is resorted to in exceptional cases, when TUR is contraindicated (for example, with large tumors and diverticula). In addition, it is an open resection that makes it possible to carefully examine the organs adjacent to the bladder and, in case of damage to the lymph nodes, immediately remove them.
Advantages of TOUR
It implies excision of the tumor in a minimally invasive non-traumatic way, without a peritoneal incision. Transurethral resection of the bladder takes place in several stages:
- The affected organ is filled with sterile saline.
- A cystorezectoscope is inserted through the urethra (urethra) - a special device equipped with a tiny camera that removes a cancerous tumor or a benign polyp.
- Pathological tissues are scraped off by a cystorezectoscope in layers, up to complete removal and partial capture of a healthy wall of the bladder.
- Upon completion of the operation, the resulting material is sent to histology.
All manipulations are carefully monitored by displaying the image on the monitor. After part of the affected organ has been removed, a catheter is inserted into the patient.
Unlike cavity partial cystectomy, TUR has several advantages:
- tissues are injured much less;
- body functions are fully preserved;
- lower risks of bleeding and other complications;
- faster recovery period;
- getting up and walking is allowed a few hours after the resection;
- no danger of seam splitting.
How is transurethral resection performed?
Indications for TUR is a diagnosed cancer tumor in the first stage:
- not growing in the muscle layer;
- the tumor size not exceeding 5 cm;
- lack of metastases in the lymph nodes of the pelvic organs;
- full functionality of the urethra.
In the postoperative period of transurethral resection of the bladder, frequent washing of the organ with antiseptic solutions is carried out in order to prevent its bacterial infection. If the operation was successful and the patient is recovering, the catheter is removed after a few days, and in the presence of complications it can be left for several weeks.
It will take at least three months to fully recover from surgery. During this period, the patient is forbidden to lift weights, sit for a long time, it is recommended to refrain from driving a car. Mandatory is a salt-free diet.
What patients say
According to reviews, resection of the bladder by the transurethral method is completely painless. Generally, general anesthesia is not required for this manipulation. Due to local anesthesia, pain during the intervention is not felt. The manipulation itself takes no more than an hour.
After surgery, many experience a burning sensation, urination, cramping. Such discomfort is noted over the next few days. Within 7-10 days, blood impurities in the urine may be observed.
Hospitalization with transurethral resection lasts 2-3 days.
Contraindications to resection
In some cases, partial removal of the bladder is impractical, so doctors decide on the complete removal of the organ. In addition, open or transurethral resection of a tumor of the bladder is not carried out with severe deformation of the organ, bleeding. TUR is not recommended in the advanced stages of cancer, when the tumor grows in all the walls of the bladder and affects nearby organs.
If the patient is diagnosed with superficial cancer, which is prone to relapse and cannot be treated with chemotherapy, radiation, cystectomy is considered the more preferable option. Complete organ removal is recommended for large neoplasms (more than 5 cm). In extremely rare cases, they resort to resection of the neck of the bladder - usually if the tumor is localized in this area or the vesicoureteral triangle, it is removed together with the organ.
Cystectomy
During the operation of this type, the probability of removal of neighboring organs affected by the tumor is not excluded. Surgeons take such a step in cases where a different decision carries mortal risks for the patient.
Access to the bladder during cystectomy is obtained through a suprapubic incision. The surgeon carefully dissects all ligaments of the organ, conducting its mobilization. The next stage is the ligation of all blood vessels that feed the bladder, and cauterization of veins that carry out the outflow of blood. After this, a clip is applied to the urethra section, located as close to the bladder as possible, to prevent it. Next, the organ is brought to an open wound, exfoliated from nearby tissues and removed from the cavity.
Cystectomy is contraindicated for patients in serious condition, which allows only palliative therapeutic actions to ensure the outflow of urine.
Laser removal of a portion of the bladder
Such an intervention for diseases of the bladder practically does not cause complications. Endoscopic laser treatment promotes quick recovery. There are no consequences of a bladder resection, but the likelihood of short-term pain and burning is not ruled out. The risk of developing erectile dysfunction after laser resection is an order of magnitude lower than after TUR. Removing part of the affected organ with a laser allows the patient to give more favorable prognoses.
What can be the complications
During the operation or in the postoperative period of the bladder resection, some complications may occur.
- blood clots and blockage of blood vessels;
- discovery of internal bleeding;
- perforation of the walls of the organ;
- bladder infection
- acute urinary retention.
The success of an open, transurethral and endoscopic resection largely depends on the experience and skill of the surgeon, the age of the patient and the severity of his general condition.
Health after surgery
At the end of the manipulation, the patient is set up the system necessary to control the functioning of the operated organ and prevent urinary retention. During the first day after the bladder resection, the patient is not recommended to drink or eat, but if a couple of hours after the operation there is no nausea, it is allowed to drink a little water. With positive dynamics, liquid or light food can be consumed the next day. You will learn about the patient’s diet for a speedy recovery in the next section of the article.
In order to avoid the consequences of a bladder resection performed with epidural anesthesia, the patient is forbidden to rise and move during the first day. Throughout the next week, he will have to take antibiotics. After removing the catheter, discomfort, pain, frequent urination, cramps and burning in the urethra can occur. Side effects usually go away after a couple of weeks. Otherwise, if the pain does not stop, and blood impurities are still observed in the urine, you should consult your doctor.
Diet features
Proper nutrition will not relieve pain and pain after surgery, it will not help to avoid urinary retention, but dieting will provide additional guarantees for a speedy recovery and restoration of immunity. In the diet of a patient who underwent a bladder resection, include liquid or semi-liquid food without salt and spices.
The patient needs to drink a lot of fluids daily, but at the same time give up a number of dishes and products. Under the strictest ban, any fatty, smoked and fried foods. Instead, it is recommended to use boiled or steam meat of poultry, rabbit, sea fish, low-fat cottage cheese.
Where to make a bladder resection in Moscow
If the patient has all the indications for the operation, he can do it for free in the urology departments of budgetary medical institutions.
In private clinics, the cost of such operations can vary significantly. On average, the cost of transurethral resection varies from 100 to 130 thousand rubles, open cavity resection is estimated at 50-70 thousand rubles, and the complete removal of the organ is more than 150 thousand rubles.
Among the Moscow clinics where they perform such an operation for a fee, it is worth noting several modern medical institutions whose patients have the opportunity to receive specialized medical care according to international standards. The staff of these clinics employs highly qualified specialists who have undergone internships in the USA, European countries, and Israel. You can make a bladder resection in such institutions in Moscow:
- "European Medical Center" on the street Schepkina.
- Clinic "Medicine" on the per. 2nd Tverskaya-Yamskaya.
- GMS Clinic Medical Center at ul. Yamskoy.
- Medical Academy "Genesis" on Leninsky Prospekt.
- Clinic "First Surgery" on the street Schukinskaya.
- Clinical Road Hospital N. A. Semashko JSC Russian Railways.
In order to improve the prognosis and prevent the development of dangerous complications, it is important to undergo thorough preparation for the operation, and after it - strictly follow all the doctor’s instructions.