CAT scan: negative.
Surgery: Radical Cystectomy and Neo Bladder reconstruction scheduled for 19 November 2010.
Post surgery hospital stay: 4-6 days
Recovery: 6-8 weeks.
(Warning: the following may contain TMI for some folks)
CAT Scan results were negative. Which is definitely a positive, good thing! Whew! There is no sign of the tumor coming back or any other lumps or bumps in the organs, fat, muscles, or lymph nodes surrounding the bladder. Surgeon says this is the optimal condition to go ahead with the surgery to remove the bladder.
The obvious question is; "Why go ahead and take it out if there's no longer any sign of cancer?"
The answer is that there are most likely microscopic cancer cells remaining in the muscle tissue of the bladder wall that may - will probably - start growing again and either produce another tumor in the bladder or metastasize and produce a tumor in the lungs, liver, or some other organ that I can't live without as 'easily' (if at all) as the bladder.
There are basically three surgical options for what to do after removing the bladder (and prostate). These are explained on the WebMD Site [ Click Here ].
I have chosen the Neo-Bladder ( continent reservoir with Orthotopic diversion ) because it doesn't require a stoma ('port' in my side) and, since all the plumbing is reconnected, it should allow the return to the closest thing to 'normal' after surgery. The main down side is the potential for problems with incontinence (leakage) since the sphincter that we normally use to control flow is removed with the bladder. However there is a muscle that we (as adults) normally only use to stop flow that we can train to control flow as well (start doing kegels now). Typically around 10% of men experience 'leakage' during the day and 20% during the night.
Some other possible problems relate to the differences between intestine tissue and bladder tissue for bladder function.
- The bladder has muscles in the walls that are used to squeeze out the urine. Intestines don't so I will need to learn how to relax when peeing while applying manual pressure to my lower abdomen (while sitting).
- The intestines have a natural population of microorganisms that are not completely removed by antibiotics prior to surgery and cannot be completely removed from the neo-bladder subsequently. This means that any subsequent urine tests will read positive for 'infection'.
- The intestines produce a mucoid lining that the neo-bladder will continue to produce for some time after surgery. This may block the urethra and cause problems with peeing. They will teach me how to clear this (back-flush the system?).
During surgery they will remove the bladder and prostate along with some surrounding fat and lymph nodes. He will be very careful to spare the nerves around the prostate that extend down to the penis by not cauterizing excessively in that area.
they remove a 60 cm. (~2 foot) section of small intestine and form it into a pouch to replace the bladder. He connects the ducts from the kidneys to the top and the urethra (to the penis) to the bottom.
He will create a stoma in my side (temporary) and insert stints into the tubes from the kidneys that pass out the stoma. A catheter will installed from the new bladder through the stoma. A Foley catheter will be also be installed through the penis. These three drainage devices will be removed (in some order that I have forgotten) and the stoma closed during recovery.
Recovery should take 4-6 weeks and during that time I should be able to gradually resume my normal schedule but without any lifting. They will work with me to get used to the operation and maintenance of the new bladder.
Debi asked how many of these surgeries Dr. Caropreso has performed. He said about 6 per year.
Why wait so long for surgery? Want to make sure all effects of Chemo have passed and body has rebuilt it's ability to heal. Operating too soon will make the recovery longer.
We scheduled surgery for 5 weeks and 3 days after my last infusion.