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Bladder resection is an operation that involves cutting out part of the bladder.
It is performed for certain diseases, mainly for tumors, bladder diverticula, etc. Bladder resection can be performed in two ways: open or transurethral (through the urethra using endoscopic techniques).
Both methods have their own indications and contraindications, advantages and disadvantages.
Open resection of the bladder is performed by opening the wall of the bladder and removing the tumor (or performing other necessary manipulation). This method today is inferior in “popularity” to such a method as TUR (transurethral resection). This is understandable: there is no scar on the body, much less tissue trauma, and therefore fewer complications. But still, sometimes you have to resort to this resection method.
Indications for open resection of the bladder
The main indication for open resection of the bladder is its tumor diseases. Resection is also performed for bladder diverticula, when there is a sac-like protrusion in its wall. However, in this case, the course of the operation is somewhat different from resection for a tumor.
Contraindications to open resection of the bladder
Contraindications to surgery are the patient’s serious condition, serious concomitant diseases, and blood clotting disorders.
Method of operation
The operation is usually performed under general anesthesia. Therefore, before the intervention, the patient is examined by an anesthesiologist, who assesses his general condition and chooses the optimal type of anesthesia.
Open resection surgery is performed by cutting the wall of the bladder. The incision in the suprapubic region is usually longitudinal in the middle or arcuate. The surgeon accesses the bladder layer by layer. After this, the surgeon mobilizes it, that is, separates its wall from the peritoneum. This is done so that the bubble can be removed into the wound and it is more convenient to carry out its resection. The wall of the bladder on which the tumor is located is freed from the surrounding fatty tissue and resected within healthy tissue. The resulting defect in the bladder wall is sutured with catgut sutures, which resolve on their own after a certain time.
A drainage tube is left at the resection site and drained through the wound. After this, the wound is sutured. If the tumor is located on the posterior wall of the bladder, resection can sometimes be performed from the cavity of the bladder itself.
In addition to the actual resection of the bladder wall affected by the tumor, if necessary, simultaneous resection of other organs can be performed: the prostate gland and seminal vesicles.
If the tumor is located in the area of the ureteric orifices, when it is necessary to excise the bladder wall along with the orifices, reimplantation of the ureters is carried out: they are sutured to the bladder wall. This stage of the operation, of course, is technically difficult and is carried out only in specialized clinics.
After the operation, a urethral catheter remains in the bladder to drain urine.
CAN'T BE TREATED: WHAT DO YOU NEED TO KNOW ABOUT THE BLADDER?
It’s easier to talk about a bad heart than about the difficulties that arise when going to the toilet. Uncomfortable and embarrassing.
But our man doesn’t like to go to the doctor. Sometimes the patient does not even know which specialist treats diseases that in one way or another affect bladder function. Meanwhile, even such an unpleasant disease as urolithiasis has both prevention and effective treatment. The main thing is to start it on time.
Honored Doctor of Russia, Head of the Department of Urology of Moscow City Clinical Hospital No. 57, Head of the Department of Urology of the Federal Medical and Biological Agency, Prof., Doctor of Medical Sciences, talks about urological diseases that are common today, methods of their treatment and methods of their prevention. Alexey Georgievich Martov.
Alexey Georgievich, tell us about the most common urological diseases. Do they have a relationship with the patient's age? — The most common urological diseases are urolithiasis, various urinary disorders and oncological diseases of the genitourinary organs. To our great regret, urological diseases affect both children and adults. Of course, they occur more often in adults than in children. However, right from birth, even during the period when the child is in the womb, he can be diagnosed with urological diseases.
And the most important thing today is that even in the womb a child can have surgery.
Urolithiasis most often occurs in young and middle-aged people who are most able to work. And of course, age-related diseases... As an example: in women - stress urinary incontinence, when urine leaks when coughing, when lifting heavy objects, and in men - prostate adenoma, a benign tumor that interferes with urination. Such diseases are more common in older people. Oncology is closer to middle and old age (such diseases also occur in children, but quite rarely).
Speaking of older men and women, what are the most common bladder problems? — Most problems in older men associated with emptying the bladder are caused by the occurrence of adenoma and prostate cancer. Bladder cancer - this problem also mostly affects middle-aged and elderly people. Women can have cystitis at absolutely any age, but most often they occur during menopause. This is due to a decrease in the “barrier” function in the body, which can lead to inflammatory processes in the bladder. Cystitis is rare in men. Overactive bladder can also occur at any age.
What is the cause of such an unpleasant symptom as urinary retention? — Urinary retention is most often associated either with a disease of the urethra (trauma, inflammation), or with a benign tumor—prostate adenoma. This disease is often accompanied by a condition called “overactive bladder” (OAB). In this condition, the bladder reacts with pathological incontinence of urine.
There are a number of conditions in young patients when OAB occurs without prostate adenoma. This is a separate disease, very unpleasant, very difficult to treat, but it is currently treated conservatively, i.e. taking pills, and using various surgical aids.
Can diseases of the genitourinary system be associated with the profession (there is such a thing as hazardous production)?
We have clear data on the connection with professional activity of such a urological disease as bladder cancer. For example, people who work with aniline dyes or metal processing are more likely to develop bladder cancer than those who work in other industries.
WHEN THE BEST PREVENTION IS DIET
Are there ways to prevent diseases of the genitourinary organs - other than those caused by the choice of profession?
As for urolithiasis, it is a complex complex disease based on metabolic disorders. And in development, in addition to natural factors, a large number of other reasons play a role, incl. and genetic. Therefore, there is no absolute prevention of urolithiasis. At the same time, a normal balanced diet and sufficient fluid intake, especially in hot climates, help to prevent it to a certain extent.
There is practically no prevention of cancer, as well as prevention of a benign tumor - prostate adenoma. Prevention of inflammatory processes in men - oddly enough, hygiene and normal, regular sex life. Many young patients complain of chronic prostatitis and suffer from it. Although in reality it is not always prostatitis. Maintaining hygiene and regular sex life, the absence of sexually transmitted diseases, help prevent problems with urination.
Why does urolithiasis still develop? What are its main causes, and what can the patient do to prevent and treat it? — I would like to draw your attention again to the fact that urolithiasis is a metabolic disease. To a greater extent, its prevention, in addition to prescribing medications that affect one specific link in the development of the disease, will be diet and plenty of drinking.
Diet is a universal and effective remedy, because many stones have a pronounced metabolic nature. And limiting dietary intake of substances that form stones is, of course, a factor that prevents rapid stone formation. This does not mean one hundred percent that there will be no stone, unfortunately. But stone formation will decrease!
Drinking plenty of fluids is very beneficial, especially in the fall. Watermelons, cranberries, lingonberries, and diuretic herbs contribute to increased urine output and the mechanical release of small pebbles or sand from the urinary tract, on the basis of which a large stone would then form. That is, stones pass away along with urine, and this is a preventive factor for stone formation.
MEN'S AND WOMEN'S
What are the dangers of other common diseases of the genitourinary system: cystitis and urethritis? How to prevent and treat them? — The question is quite big. Let's start with the fact that cystitis most often occurs in women, and urethritis most often occurs in men.
Why does cystitis occur more often in women? Because women have a short urethra, only 2–3 cm. Therefore, close interaction with the environment, with the genitals, and poor hygiene lead to the fact that infection easily penetrates into the bladder through a short path - this is the most common case of the disease. Much less often, cystitis occurs due to infection through the blood in other inflammatory diseases, for example, boils, etc.
Urethritis is inflammation of the urethra. Its causes are: poor sexual hygiene, sexually transmitted diseases, and any insertion into the urethra (instruments, non-sterile medications, foreign bodies, etc.).
What are the main ways to prevent cystitis in women? — Sexual hygiene, timely consultation with a gynecologist, and if acute cystitis occurs, consultation with a urologist and treatment according to certain standards. It is necessary to carry out a normal therapeutic course so that the disease does not become chronic!
How to treat urethritis in men? — Only inpatient treatment after consultation with a urologist. Prevention - absence of promiscuity, use of condoms, carrying out manipulations only in clinics, with sterile instruments.
Do childbirth and pregnancy affect the development of urological diseases? — Sometimes during pregnancy a condition occurs when the fetus puts pressure on the ureter, i.e. the collector that carries urine from the kidneys to the bladder. An obstructive inflammatory process occurs, which is called “pyelonephritis of pregnant women.”
Also, pregnancy and childbirth - especially pathological or complicated labor - can affect the anatomy of the pelvic floor, which can be accompanied by urinary incontinence. Another fact, proven to a lesser extent so far: we can again see that during pregnancy a number of patients develop urolithiasis.
This is a rather complex disease, the causes of which, as we have already said, are many. But one of them is metabolic disorders during pregnancy.
What effect do diseases of her genital organs have on a woman’s bladder? — The bladder and urethra are very close to the vagina, so the bladder is affected by all inflammatory diseases of the vagina and its vestibule. They can cause inflammation in the bladder. Any processes in these organs are interconnected.
NERVES, INJURIES, OPERATIONS
How does the nervous system affect the functioning of the bladder? — This is a separate and very broad topic. People with urinary problems associated with spinal cord and brain injuries are a very difficult group of patients. The spinal cord is responsible for all functions of the bladder. Treating the problem is also difficult. A small group of drugs affects urinary dysfunction due to damage to the nervous system.
There are also special electrical stimulation techniques. A person is implanted with special neuromodulators that send impulses to the bladder, thereby restoring urinary functions. It's very difficult.
In addition to overactive bladder, there is also neurogenic bladder, which is difficult to treat. The causes of this condition are spinal injuries and fractures. Neurogenic bladder is treated by specially trained urologists and specialists in nervous diseases.
How correct is it to associate injuries with urological diseases? - If a traumatic agent passes through the genitourinary organs, then injury, of course, can occur. Injuries may be accompanied by ruptures of the bladder, kidney or urethra - and in such cases require emergency surgery. The consequences of the operation may affect the development of diseases of the genitourinary system, but trauma is not the most common cause.
The most common cause of urological disease is trauma to the urethra, which occurs, for example, when playing football or riding a bicycle. The urethra is a very delicate organ, and after such incidents it often narrows. This is a very unpleasant disease that often requires surgical correction.
What do patients who are forced to remain immobile for some time after undergoing operations need to know about the prevention of urinary problems?
It depends what time it is. Women usually have a catheter placed in their bladder for the postoperative period. It can remain in the urethra for quite a long time. Women have a short urethra - and they tolerate the presence of a catheter in the bladder much more easily. They experience fewer inflammatory complications. Of course, such procedures need to be monitored. Urologists usually tell patients how to properly care for themselves during this period and how to handle the catheter.
Men can also have their bladder drained through the urethra, but for a short period. For longer periods, in men and those who do not have a functioning bladder at all, a suprapubic puncture is usually performed and the urine passes passively through a tube that is inserted into the bladder. Some patients with a non-functioning bladder undergo self-catheterization, i.e. excrete urine independently at certain hours.
Prevention after surgery involves maintaining sterility, using anti-inflammatory drugs, and modern catheters with antibacterial coating. This helps prevent, especially in men, the development of urethritis.
How do urological problems affect a person’s quality of life, his communication with family, friends, and colleagues? - Of course, if urine is leaking, it is very important to monitor hygiene. A person who smells becomes antisocial. And he may stop communicating with other people altogether.
Fortunately, today medicine has all the means that can make a patient with such problems completely healthy and socially active. There are urinals that do not allow odor to pass through. You can safely work, drive a car, etc. with an artificial bladder. There are catheters and urinals that are attached to the human body in such a way that they do not interfere with his movement.
When men leak urine, they use special soft pencil clamps that prevent urine from leaking out. And when a person wants to urinate, he opens this clamp. The most advanced system is an artificial bladder sphincter, which is controlled directly by the person himself. Visually, these devices are not noticeable in any way.
ALL DISEASES ARE HEALTHIER FOR US...
Can the patient do any muscle training exercises that may help with urinary incontinence, for example?
There is a set of exercises that is aimed at strengthening the pelvic floor muscles. Of course, such exercises can only be shown to the patient by a specialist - a urologist or gynecologist working in the field of urogynecology.
The person will need to learn how to perform the exercises correctly. Considering that relatively older women can help themselves in this way, the first training courses should take place under the supervision of a doctor. Gymnastics is quite effective: by strengthening the pelvic floor muscles, it becomes possible to prevent urinary incontinence. This is done by urologists and gynecologists working in the field of urogynecology.
Men, like women, have a similar problem. There are many reasons, but most often incontinence is associated with surgical interventions on the prostate gland and urethra, which were accompanied by injury to the urethral sphincter. If this sphincter is completely destroyed, then nothing can help except implantation of an artificial sphincter. If partially, then drug therapy and physiotherapy complexes help. This is a common practice in all hospital departments, and patients are willing to undergo such procedures.
For prostate cancer, the main treatment method is removal of the gland. In addition, the patient's urethra is sutured to the bladder and an anastomosis is performed. One of the consequences of the operation is urinary incontinence. Thanks to the development of medicine, it is now rare and is observed in the early postoperative period.
But even this unpleasant complication goes away quite quickly thanks to the use of a set of physiotherapeutic exercises.
Course of the postoperative period
In the postoperative period, the patient usually receives antibiotics to prevent infectious complications and painkillers. Sometimes it may be necessary to carry out auxiliary (adjuvant) treatment methods when removing a malignant tumor: chemotherapy or immunotherapy.
The sterile dressing is usually changed every few days. The sutures are removed on the 7th - 8th day. The urethral catheter is removed depending on the patient’s condition on the 7th - 10th day.
In addition to dressings, daily rinsing of the bladder through a catheter is mandatory. For this, sterile furacillin is usually used. This is done both to prevent infectious and inflammatory complications and to avoid the accumulation of blood clots in the bladder cavity.
Postoperative complications
Postoperative complications during bladder resection include: bleeding, infectious and inflammatory complications.
There is a risk of long-term postoperative complications. One of them is the formation of a postoperative hernia. This complication is typical not only for bladder resection operations, but also for all other operations involving dissection of the abdominal wall.
Another long-term complication of the postoperative period is tumor recurrence.
Diagnostics
A prerequisite for diagnosing various bladder tumors is a detailed consultation with an oncologist. At an appointment with a medical specialist, the patient’s complaints are analyzed, his general examination is performed, as well as a transrectal examination to detect lumps and foreign formations. The clinical diagnosis can be confirmed using the following additional examination methods:
- analysis to identify tumor markers for bladder cancer;
- bacteriological examination of urine;
- general clinical and biochemical blood tests;
- general urine analysis and Nechiporenko study;
- ultrasound examination of the pelvic and abdominal area;
- transrectal ultrasound examination of the prostate gland;
- urethrocystoscopy;
- magnetic resonance imaging of the pelvic region;
- chest x-ray;
- cystoscopy and fluorescent cystoscopy technique.
