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"When I think of hanging up a urine bag to talk to others about business, hanging a urine bag to accompany my daughter to swim, hanging a urine bag and going on a trip with my wife, I can't accept it!"
In the past six months, Mr. Wang (pseudonym), who was found to have invasive high-grade bladder cancer, has done countless psychological constructions, but he cannot accept the unanimous advice given by many hospitals: complete bladder incision and wear urine bags for life.
At the same time as he repeatedly struggled with the operation, his condition deteriorated, and hematuria became more and more frequent, and there was no longer any delay. With the persuasion of his family and the ruthlessness of the disease, Mr. Wang was forced to come to the Department of Urology of Shaw Hospital affiliated to Zhejiang University School of Medicine.
In this public hospital, which is known for its minimally invasive, a new solution has given Mr. Wang a new life.
The operation was delayed again and again
All because of the reluctance to "hang urine bags"
Mr. Wang is 45 years old this year, with a smooth career and a harmonious family. However, half a year ago, he was unfortunately diagnosed with bladder cancer, and the change of diagnosed with multiple high-grade urinary epithelial cancer has caught him off guard, and many hospitals have given radical bladder total resection surgery plans to make him more depressed.
In the face of Chen Yicheng, chief physician of the Department of Urology of Zhejiang University Shaw Hospital, Mr. Wang directly asked "three questions":
Doctor, why do I have to have a full bladder removal?
Can I do surgery without hanging a urine bag?
How long would I live without surgery?
Chief Physician Chen Yicheng patiently explained to Mr. Wang that whether or not to remove the bladder is determined by the nature of the disease.
Generally speaking, bladder cancer is divided into non-muscular invasive bladder cancer and muscle-invasive bladder cancer, the treatment method is mainly surgery, the former can be used transurethral bladder tumor resection (TURBT), through the cystoscopy to accurately find the tumor with electrical resection with electric resection; the latter is invasive bladder cancer, the standard treatment is radical bladder resection, postoperative urinary diversion.
Mr. Wang's bladder cancer is the latter, if you do not undergo radical surgery as soon as possible, the cancer cells are easy to spread to other tissues, and the opportunity to completely eradicate it will be lost.
When it was learned that half a year had passed since the diagnosis of bladder cancer, Chief Physician Chen Yicheng pinched a handful of sweat for the patient, fortunately, the re-imaging examination only suggested that the bladder lesion was enlarged, and did not suggest metastasis in other parts.
"There must be no more delay!" Chief Physician Chen Yicheng once again suggested that Mr. Wang undergo surgery immediately, but at this time Mr. Wang was still hesitant.
What made him hesitate was not the operation itself, but the post-operative period. Because after the traditional radical cystectomy, it is necessary to do ileal bladder urine flow diversion (also known as Briker urinary diversion), which means that you need to "hang urine bags" for life. This is the crux of Mr. Wang's delay in operating.
Seeing Mr. Wang, who was worried about it repeatedly, Chief Physician Chen Yicheng introduced him to a new surgical method - in situ ileal new bladder surgery. This suggestion made Mr. Wang's eyes light up.
In situ ileal neobladder surgery
Say goodbye to the embarrassment of urine bags and improve the quality of life
Chief Physician Chen Yicheng said that the traditional ileal bladder urine flow diversion (also known as Briker urinary diversion) is to sew both ureters that have nowhere to go into a section of the ileum (end-sided anastomosis) after bladder resection, and then perform an abdominal wall stoma at the distal end of the ileal passage to connect the storage bag. This surgical method is simple to operate, the hospital stay is short, the patient cost is low, and the postoperative management is simple, so it is currently commonly used.
However, as Mr. Wang feared, Briker surgery will also bring a lot of troubles to patients. Because of the urine storage bag hanging on the body, the patient is basically unable to carry out strenuous exercise such as running, swimming, and playing ball after surgery, and the quality of life is reduced. Moreover, after a long time, the patient's body inevitably emits an unpleasant smell, which makes the patient feel embarrassed and inferior on various occasions, and the dignity is seriously affected. Especially for young patients with high social requirements, this technique is prohibitive.
Clinicians have carried out successive explorations, and in situ new bladder surgery has emerged.
"This surgery involves the interception of a segment of the gastrointestinal tract, which goes through steps such as deconstruction and folding to rebuild a new bladder in the pelvic cavity. The new bladder is sutured with the urethra, so that the patient can urinate through his own complete urethra after surgery, without having to hang a urine bag on the body, which has achieved anatomical and functional recovery to a large extent, and the quality of life has been greatly improved. Chen Yicheng explained.
According to reports, the most commonly used material for in situ neobladder surgery is the ileum. The ileum is convenient for taking materials, and the length of the ileum in normal adults is 3 to 4 meters, and the removal of some of them will not affect digestion and absorption. Moreover, the new bladder caused by ileal modification is low in pressure, large in volume, and good in compliance, which is conducive to protecting kidney function.
In 2004, the WHO/SIU/ICUD conference established neostysitary bladder in situ as the gold standard for urinary tract reconstruction after radical cystectomy. However, due to the complexity and difficulty of the surgical steps, many hospitals have not carried out it.
In recent years, the vigorous development of surgical robots represented by "da Vinci" has made in situ neobladder surgery more and more the focus of bladder cancer treatment.
Zhejiang University Shaw Hospital explores the implementation of new bladder surgery under the robot with the leading level of minimally invasive and robotic surgery in China. At present, a number of cases of robot radical total resection of the lower bladder + in situ ileal bladder replacement have been successfully implemented, accumulating rich experience and bringing good news to bladder cancer patients.
High-tech skills take turns
5 h fine suture
Say goodbye to the plight of tumors and return to normal life
Earlier this year, the operation was carried out at the Robotic Surgery Center of the Qingchun Branch of Zhejiang University Shaw Hospital. In order to minimize the trauma to the patient, Chief Physician Chen Yicheng decided to use single-hole robotic surgery technology, that is, to complete the resection of the bladder and the reconstruction and anastomosis of the in situ bladder through a hole.
It's a whole new attempt.
During the operation, under the field of view magnified by a factor of 12 by the robot assistance system, the three robotic arms are finely cut. The patient's bladder and lymph nodes are completely removed. Then take a small section of the ileum and sew it into a brand new bladder. At the same time, the disintegratible ileal stent invented by The Director of Run Run Run Shaw Hospital, Tsai Xiujun, quickly restored the continuity of the intestine. Then under the dexterous arms of the robot, the new bladder was anastomated with the original urethra, and the operation was very smooth, with less than 100 ml of intraoperative bleeding.
1 week after the operation, the patient resumed defecation, removed the drainage tube, and was successfully discharged from the hospital. A month later, in the outpatient clinic of Chief Physician Chen Yicheng, Mr. Wang removed the ureter stent tube and catheter, and completely restored his healthy appearance. Under the careful guidance of the doctor, Mr. Wang began the functional training of the new bladder.
After another 1 month, when Mr. Wang appeared in front of Chen Yicheng again, he was as new as a new life, he happily shook the hand of Chief Physician Chen Yicheng and said: "I already knew that with this technology, I didn't have to drag it out for so long, now in addition to the number of urinations, it is exactly the same as healthy people, you can go out to see friends, you can take a bath and swim, I think I can also respond to the national three-child policy." ”
Surgery is not once and for all
Prevention and protection of the bladder is more important
Chief Physician Chen Yicheng reminded that there is no once and for all treatment for any disease, and the new bladder of the in situ ileum is difficult to feel the urine filling because the new bladder is more difficult to feel, and the contraction of the ileum is not controlled by the subjective will of the person, so the new bladder cannot be completely controlled like the bladder. Therefore, in order to achieve functional recovery, patients need to undergo a series of new bladder control training under the guidance of medical care, and regular follow-up is required.
For ordinary people, prevention is always greater than cure. According to the Data of the National Cancer Registry, bladder cancer is one of the most common tumors in the urinary system in mainland China, and its incidence is increasing year by year, with more males than females, and the incidence of urban population is higher than that of rural populations.
Smoking is a major causative factor in bladder cancer, with an estimated 50% of bladder cancers associated with smoking, while quitting before the age of 50 reduces the risk of bladder cancer by about 50%.
Occupational exposure is also a clear risk factor, involving industries such as fuel, dyes, rubber, leather, haircuts, truck drivers, etc. It is recommended that relevant practitioners do a good job of protective measures, diligent physical examination, pay more attention, find early lesions, and treat them in time.
In daily life, drinking more clean water to increase the frequency of urination can reduce the contact between carcinogens and the bladder epithelium, thereby reducing the risk of bladder cancer. Cruciferous vegetables and citrus fruits have been shown to have a significant protective effect on the bladder.
Finally, Chief Physician Chen Yicheng also reminded the majority of patients once the naked eye can see hematuria, do not take it lightly and seek medical treatment as soon as possible. Cystoscopy is an effective test for early bladder cancer. At present, Run Run Shaw Hospital routinely uses slender soft electronic cystoscopy, and the majority of patients should not delay diagnosis and treatment because they are afraid of cystoscopy.
Source: Department of Urology, Run Run Shaw Hospital
Original works, reprinted please indicate the source and source
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