Blood in the urine – we speak of hematuria –, polyps spotted on the images (MRI or CT scan): this may be a sign of bladder cancer. The diagnosis is confirmed (or not) after analysis of the polyp(s).
“In some cases, it is immediately a very aggressive cancer, a urothelial carcinoma. This high-grade tumor appears on the lining of the bladder and is likely to deeply infiltrate the muscle”introduced Dr Laurent Lopez, urologist (1).
Doctors are then forced to consider major surgery: a cystectomy, in other words the removal of the bladder. “This option does not concern more than a quarter of patients, but for a long time it was synonymous with a loss of quality of life for them because it involved a urinary stoma, in other words a diversion of the urinary tract opening onto the abdominal wall and connected to a pocket” and particular difficulties in women, to preserve the genitals.
This is no longer systematically the case today.
Preserving continence and sexuality
“We are now able to treat the patient with curative surgical techniques that allow healing while preserving quality of life, urinary continence and, when possible, all external and internal genitalia,” details it urological surgeon.
“Advances in surgical techniques, and in particular the development of minimally invasive robot-assisted techniques, make it possible to remove this type of tumor without opening and to reconstruct a new bladder, most often with a segment of the bladder. intestine In most cases, this type of intervention makes it possible to maintain urinary continence and, depending on age, comorbidities and the existence or not of active sexuality in the preoperative period, long-term preservation of sexuality. .”
But this is not always possible, tempers the surgeon. The initial cancerological criteria are decisive.
-To summarize, “we can say that the earlier the cancer is caught, the easier it is to consider this type of solution”. These techniques, finally specifies the urologist, “require a fairly long surgical apprenticeship.”.
They are most often implemented in expert centers, which operate on a large number of cases, generally large anti-cancer centers.
1. He presented a conference on “urothelial tumor in women” as part of the UroPaca Meetings organized this fall in Toulon.
In humans
In the context of a cystectomy in men, neurological preservation (nerve-sparing) is just as complex as the preservation of the genitals in women.
But again, “surgical advances, oncological treatments and anatomical discoveries also make it possible to combine the three objectives – curative, functional and maintenance of quality of life – to achieve the cure of cancer, the preservation of continence and the safeguard of sexuality.”
