Surgical treatment of bladder cancer

Bladder tumors are more likely to occur in the bladder triangle. If the tumor is located in the bladder triangle and the bladder neck and has infiltrated, the tumor has metastasized to the surrounding lymph nodes, or the tumor is recurrent, radical cystectomy should be used. At present, the treatment of bladder cancer is still mainly surgery. In clinical work, the specific scope of surgery and treatment plan are formulated after comprehensive analysis of the tumor stage, malignancy, pathological type, location, whether it involves adjacent organs, and the patient's condition:

1. Transurethral surgery

① Electrocautery: During cystoscopy, if non-invasive superficial papilloma (stage Ta), single or a small number of scattered tumors, with a tumor volume of more than 1 cm, can be treated with electrocautery through the urethra.

② Transurethral electroresection: It is suitable for pedunculated papilloma of about 2 cm or small pedunculated tumors in the shape of a mass or mulberry, and superficial bladder tumors that have not yet invaded the deep muscle (T2 stage). Transurethral electroresection can be performed using an electroresectionoscope.

2. Partial cystectomy

It is suitable for invasive papillary carcinoma with limited scope. The tumor should be far away from the bladder trigone and bladder neck. The depth of invasion should not exceed the fat layer around the bladder. Ureterocystostomy can be performed if necessary.

3. Local cystectomy and electrocautery

The scope of application is similar to that of transurethral surgery, namely, bladder papilloma with shallow infiltration, low malignancy and thin base.

4. Total cystectomy

Radical cystectomy should be used for tumors that are beyond the scope of the above surgical methods, tumors located in the bladder trigone and bladder neck with infiltration, tumors that have metastasized to surrounding lymph nodes, recurrent tumors, etc. Urinary diversion surgery such as ureteral transplantation must be performed on the severed ureter.

Commonly used diversion surgeries include: ① ureterostomy; ② rectal bladder and sigmoid colostomy; ③ rectal bladder surgery; ④ ileal bladder surgery; ⑤ controlled ileal pouch bladder surgery.