The robot as a reinforcement in the treatment of bladder cancer

You wouldn’t expect to have bladder cancer at the age of 45. But that’s exactly what happened to Cédric a few months ago. He is being cared for at Arnaut-Tzanck Mougins Private Hospital and is now recovering and getting better by the day (read below). dr Jean-François Dessyn, the urologist who treated him, gives an update on this pathology.

“All organs combined, bladder cancer is the 8th type of cancer (4th in men, 7th in women) and 13,000 new cases are diagnosed in France every year. There are two types: 70% are non-muscle-infiltrating bladder cancers (MIVT) and 30% are muscle-infiltrating bladder cancers (MIVT), which are more serious.

Blood in the urine, trouble urinating

A symptom that should quickly alarm is the presence of blood in the urine (or gross hematuria), especially in smokers. While it may have another cause, it’s important to consult your doctor, who can refer you to a urologist if you suspect cancer. “There are other warning signs: urination problems, frequent urge to urinate, urgent need to urinate (urgency), urinary burning or even constipation. Pain in the lower abdomen occurs less frequently.”, lists Dr. Dessyn up. To make the diagnosis, the essential examination is cystoscopy, during which a camera is naturally inserted into the bladder. “This allows us to detect the presence of polyps, which may be removed for analysis. The anatomopathological examination determines whether the cancer is invasive or not and derives the therapeutic choice, which is carried out in a multidisciplinary consultation session (RCP). It is also advisable to have a CT scan to make sure there is no lesion higher up.

In the case of non-invasive bladder cancer, several therapies can be considered, depending on the stage. “They are administered by instillation: it is minimally invasive since it consists in passing a product into the bladder and allowing it to infuse for two hours before being emptied naturally when the patient urinates. Depending on the type of cancer, we can also offer intravesical chemotherapy over 8 sessions. Or, for the highest grade polyps, immunotherapy: this time we proceed with 6 instillations of BCG (Bacille Calmette-Guérin).”

Reconstruction of a neobladder

More serious, invasive bladder cancer requires “an extended examination that allows us to see if the disease has spread throughout the body. If it remains localized in the bladder, we start neoadjuvant chemotherapy via the venous route. In a way, this amounts to bombarding the body to “erase” these lesions and reduce the risk of micrometastasis spreadingsays dr Dessyn. We then proceed to the surgical treatment, which consists in removing the bladder as well as the prostate in men (radical cystoprostatectomy) and the uterus in women (anterior pelvectomy), all combined with a lymph node dissection. During the same operation, a piece of the digestive tract taken from the patient is used to reconstruct an ileal neobladder, which is formed into a reservoir. It is connected to the ureters — the tubes that carry urine from the kidneys — and to the urethra — which allows urine to pass out during urination. The other option, which is reserved for more fragile patients, is the so-called bricker bypass: This time the digestive tract, which serves as a reservoir, is connected to an opening in the skin. Urine is therefore drained through a stoma (a pocket) in the abdomen. Wherever possible, we prefer the first solution, which is easier to use on a day-to-day basis. However, the patient must undergo physiotherapy sessions preoperatively to learn how to manage the sphincters and also postoperatively to restore good urinary continence. » And he will benefit from regular monitoring, accompanied by this urgent recommendation if he has been a smoker: stop smoking, the main risk factor for bladder cancer.

“My Passport to Life”

The life of Cédric K, a 45-year-old resident of Peymeinade, was turned upside down in just a few months. At the beginning of December he found out that he had bladder cancer. “I had noticed the presence of blood in my urine. The diagnosis was made after a series of tests, including a cystoscopy (the fact of looking inside the bladder thanks to a camera, ed.). My urologist, Dr. Dessyn explained to me that the cancer is aggressive and invasive. It was a big shock, I became aware of my vulnerability. He described everything that would happen without hiding anything from me but told me: ‘He would do anything to treat him. His honesty gave me confidence. I talked about it with those around me, they were very supportive, especially my 15-year-old son.”

Everything comes together very quickly. Cédric begins his treatment journey with intense chemo sessions. “It was very intense, to be honest, but above all they were very effective because they made it possible to reduce cancer.” The following: a cystoprostatectomy (removal of the bladder and prostate) thanks to the famous Da Vinci surgical robot in April. “It’s a difficult operation, but I was well prepared. dr Dessyn took the time to answer all of my questions. Anyway, I had no choice, I knew it was my passport for life.”

The procedure will take… 8 hours. After 10 days, Cédric was able to return to his homeland. He insists on stressing “The quality of care: All staff were attentive and caring.”

He had mentioned the potential consequences associated with removing the prostate. “Dr. Dessyn had spoken to me about the possibility of freezing gametes upstream, but I didn’t want to do this as I already have a child. Also, he told me after the surgery that he was able to preserve nerves to the maximum (actually preserves erectile function, ed.)”, explains Cédric modestly. Note that patients undergoing surgery of the same type can benefit from specific treatments if they suffer from erectile dysfunction.

The Azurean is now recovering. Certainly, given the importance of the treatments he’s undergone, he hasn’t fully recovered his form – he has to undergo perineal rehabilitation to ensure his continence – but he’s doing well. The only change in his life: he stopped smoking completely, “not a question of least risk”.

#robot #reinforcement #treatment #bladder #cancer

Leave a Comment

Your email address will not be published.