Most often, laparotomy is used to remove the bladder - this is a kind of surgery, in which healing is faster, and tissue trauma is minimal. The technique of carrying out such an operation consists of the following stages:
- The surgeon treats the patient's skin at the site of the alleged punctures (incisions).
- A special catheter is inserted into the urethra by means of which the urinary fluid will be excreted during the operation.
- Using the arcuate suprapubic access, the surgeon uncovers and fixes the bladder.
- The doctor opens the cavity of the bladder and examines it.
- Further, the walls of the bladder are fixed, while in men the prostate gland is fixed.
- If the ureters are not discharged outside and do not move to the part of the intestine, they are cut off in the area of healthy tissue.
- The doctor conducts a catheterization.
- In men, the vas deferens are bandaged (this is done carefully so as not to disrupt intestinal integrity).
- The bladder is pushed back and forth, bandaged, crossed by the pubic-vesicle and pre-tubercular ligament, and the urethra (in men this is done with caution, as one can touch the prostate located next to it).
- The doctor removes the bladder, places the bleeding sites, sips the vessels, and establishes drainage.
- Through an external opening in the abdominal wall, the surgeon inserts a catheter-reservoir into the urethra, forming a new bladder.
- The surgeon sutures the wound (layer by layer), leaving a place for drainage, and impose a sterile bandage.
Methods for removing the bladder
Removal of the bladder, carried out with the help of laparoscopy, is more easily tolerated by patients, and the wound heals faster after such intervention.
As for the procedure for removing and replacing the bladder, then there are several ways:
If the organ is modeled from the site of the small intestine, then a length of approximately 600 mm is used: it forms a volume formation similar to the bladder, which is connected to the ureter and the urinary tract. This variant of the operation is considered to be the most acceptable, since later the patient will be able to empty the bladder in a natural way. But this operation is not shown to all patients. For example, if a patient has tumors of the urethra or intestine, or he suffers from acute enterocolitis, then the gut can not be used for transplantation.
If the outlet for outflow of urine is taken outward in the area of the anterior wall of the stomach, a new intestinal container is simultaneously created, which the patient will periodically have to release using a special catheter.
If the ureter is connected to the small intestine, the intestinal loop can be withdrawn, and urine will be collected in a suspended reservoir. The second variant of such a connection is the excretion of the ureteral mouth into the intestinal cavity: in patients in this case, urine will be excreted from the body through the rectum, simultaneously with the calves.
Features of bladder removal
Removal of the bladder in men has some features. So, given the specific nature of the anatomical structure of the genitourinary system in the male body, catheterization should be done very carefully and carefully. The fact is that in the absence of experience, the medical specialist may have problems with the introduction of the catheter, because the male urethra is relatively long (23-25 cm), narrow and has two natural constrictions. As a result, the catheter does not pass freely.
Especially, one should be careful when introducing a metallized catheter: manipulation with such a tool is difficult, and with inaccurate use, it is easy to damage the mucosa of the urinary tract. This can lead to bleeding and even to perforation of the walls of the urinary canal. Given this, it is preferable to use a soft disposable catheter.
In addition, with radical removal of the bladder, the men also remove the nearest lymph nodes, the prostate and seminal vesicles.
Removal of the bladder in women is combined with resection of the urethra, ovaries, uterus and anterior vaginal wall. The surgeon has to eliminate other organs because in most cases the cancer cells germinate in the nearby organs: the prostate gland in men, the uterus and the appendages of a woman.
Removal of the uterus and bladder is a forced measure that allows to give a relative guarantee that the malignant process will not reoccur - that is, does not recur. Unfortunately, often the cancer spreads and germinates quickly enough, and malignancy arises even in those organs that, when diagnosed, appear to be healthy.
But the removal of the kidney and bladder is also considered a fairly rare operation, although with the kidney disease the whole urinary tract can suffer. If the tumor process (more often - transitional cell carcinoma) affects the pelvis of the kidney and ureter, it is not necessarily that it will spread to the bladder. According to statistics, this happens only in 1% of all cases of malignant lesions of the kidneys and upper urinary tract.
Many patients ask the following question: if the tumor is small and does not grow into neighboring organs, can you remove the part of the bladder rather than remove it entirely? Indeed, such operations are conducted, and they are called simple, or non-radical. However, they are rarely done, only to some patients with superficial bladder cancer. Partial removal of the bladder often leads to relapses - repeated development of the cancer process, and the operation itself is classified as difficult and can be accompanied by various unforeseen circumstances.
One of the options for partial resection is the removal of the neck of the bladder - an endoscopic procedure that is performed transurethral - through the urethra. Such an operation is performed with inflammation of the neck of the organ, in the presence of cicatricial changes in the tissues. For the procedure, a special loop is used, heated by an electric current to a high temperature. With the help of a loop, the surgeon cuts the affected tissue and simultaneously cauterizes the damaged vessels, stopping the bleeding.
If the neck of the bladder is affected by a cancerous tumor, then in the vast majority of cases the doctor will not consider the possibility of partial organ removal. Radical resection is considered more acceptable in terms of complete cure for cancer pathology.