Urological surgery to remove cancerous tissue from the body is essential for diagnosing bladder cancer and determining the extent, or stage, of the cancer. Surgery is the primary treatment for superficial (non-invasive) bladder cancers. It is also an important option for treatment of invasive bladder cancer.
Surgery for Seattle Cancer Care Alliance (SCCA) patients takes place at University of Washington Medical Center in the SCCA Prostate Oncology Center.
Cystoscopy for Bladder Cancer
Cystoscopy is a procedure in which the doctor uses a cystoscope (a thin camera inserted through the urethra) to examine the bladder and identify possible cancer lesions. The cystoscope can also be used to remove a tissue sample (biopsy) to help determine the type and stage of the cancer. It is also used to monitor superficial bladder cancers after treatment is complete.
Transurethral Resection of Bladder Tumor
For this procedure, also known as TUR or TURBT, the doctor inserts a special cystoscope called a resectoscope into the bladder through the urethra. Then the doctor uses a special wire loop to remove the cancer cells from the bladder tissue. The goal of this procedure is to remove (resect) as much of the tumor as can be done safely. This is the most common primary treatment for superficial bladder cancer and is required for diagnosis of all bladder tumors.
This surgical procedure is used when the cancer is found to have invaded the bladder muscle. The surgeon removes the entire bladder and surrounding lymph nodes in order to keep the cancer from spreading to other organs and tissues. In men, the prostate is also removed. In women, the uterus, fallopian tubes, ovaries, and part of the vagina may also be removed.
To provide for drainage of urine, surgeons must reconstruct a drainage system. There are three options for urinary reconstruction, all using portions of the patient’s intestines that have been separated from the rest of the intestines.
- Ileal conduit/loop: With the ileal conduit, an opening (stoma) in the abdomen is created to allow urine to continuously drain into an external appliance attached outside the abdomen.
- Continent cutaneous urinary reservoir (CUR): The CUR is a storage system that the patient drains every few hours using a catheter inserted through an opening in the abdomen.
- Orthotopic neobladder: This involves constructing a new bladder. SCCA and UW Medicine surgeons pioneered techniques for creating a neobladder (“new bladder”) made from a section of the bowel. It is connected to the urethra so that patients can urinate as they did before surgery.
Robot-Assisted Surgery for Bladder Cancer
SCCA and UW Medicine urologic surgeons also perform laparoscopic radical cystectomy using robotic technology (the da Vinci Surgical System, or da Vinci robot). This approach uses small incisions, 3-D telescopes, and special wristed instruments controlled by the surgeon. Although still major surgery, the robotic approach is associated with less blood loss, less pain, and improved cosmetic results with preserved cancer control.
The surgeon sits at a console near the patient and uses joysticks and foot pedals to control the arms of the da Vinci robot. One robot arm holds a camera, while two more hold the surgical instruments. The console gives the surgeon a true three-dimensional view.
Our surgeons performed the first robot-assisted cystectomy in the region in both men and women, and we lead the area in providing this type of care.