Elaborating on latest developments in Bladder Cancer Surgery

The incidences of Bladder Cancer are very high all over the world. The treatment, however, varies as per the grade and stage of the disease – from Endoscopic Tumour Resection and Intravesical Mitomycin C for low-grade diseases to Radical Cystectomy (in men) and Anterior Pelvic Exenteration (in women) for the high-grade muscle-invasive disease.

Traditionally these surgeries for bladder removal were done by a large incision extending from Pubic Symphysis right till the Umbilicus. These surgeries have always been demanding as it needs suturing in a narrow space in the pelvis which is why it requires a large incision.

In the era of minimally invasive surgery, this, later on, was taken over by Robotic Surgery which involved very small cuts on the abdomen and one small incision for Bladder specimen retrieval. However, this engages a huge cost to the patient, about Rs. 2-2.5 Lakhs extra which comes in the form of disposable consumables and Robotic Arms. Robot in itself is a huge investment for a hospital which justifies the very high cost of Robotic surgery.

To beat this cost, at Narayana Health, we use a Laparoscopy technique at just Rs. 30,000 extra to Open Surgery. This is done at very few centres in India with all the benefits to the patient in terms of small scars similar to those in robotic surgery at nearly the same cost as for open surgery. The patient goes through very less pain with a very good cosmesis and stays in the hospital is limited to just 5-6 days with early recovery and at a very affordable cost.

Majority centres in India are offering an Ileal Conduit as bladder replacement to all patients for collecting and transporting urine to a bag attached to the abdomen. The patients obviously have a permanent stoma which is a bit cumbersome to take care with a bag attached and the inability to pass urine from the native urethra.

This is mentally traumatic to the patient as they may develop low self-esteem. In carefully selected individuals, we routinely do Orthotopic Ileal Neobladder Reconstruction where an artificial bladder is made from intestines and is joined to the original urethra which offers the patient an ability to control urine and pass urine from the native urethra.

Dr. Amit Goel, Department: Urology, Uro-oncology and Kidney Transplant at Narayana Superspeciality Hospital, Gurugram

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