Robotic Surgery and Reconstruction Choices Improve Recovery and Quality of Life for Bladder Cancer PatientWhen Gloria Robertson of Brown Deer chose Froedtert & The Medical College of Wisconsin, she gained access to the most treatment options possible for her bladder cancer. An estimated 73,000 new cases of bladder cancer are diagnosed each year, and many patients aren’t aware of all possible treatment choices.
Gloria’s positive outcome started with a team approach. She had chemotherapy before surgery to shrink the tumor, robotic surgery to remove her bladder, a choice of three bladder reconstruction approaches, and access to the only support group for bladder cancer patients in the area. Gloria found all of these crucial options at Froedtert & The Medical College.
She also had her own secret weapons: a positive attitude and supportive family and friends.
Common Symptom of Bladder CancerIt started when the 62-year-old noticed blood in her urine in June 2010, a common symptom of bladder cancer. Tests confirmed the diagnosis. Gloria was referred to the Froedtert & The Medical College of Wisconsin Prostate and Urologic Cancer Program, where she saw Kenneth Jacobsohn, MD, Medical College of Wisconsin urologic oncologist.
“Dr. Jacobsohn explained that the tumor was into the muscle wall,” Gloria said. “He discussed in detail what that meant. I said ‘you do what you have to do, and tell me what I have to do,’ and we went from there.”
“A muscle-invasive tumor can be life-threatening if it’s not treated,” Dr. Jacobsohn said. “The gold standard of treatment for such patients is removal of the bladder. We also recommend the patient has chemotherapy first, because research shows it helps improve long-term survival.”
Although Gloria didn’t require it, some patients who have surgery to remove the bladder also receive external beam radiation therapy/and or brachytherapy radiation to help control recurrence. Radiation therapy used with chemotherapy to spare the bladder (non-surgical treatment) is another option for muscle-invasive bladder cancer. For carefully selected cases, this approach offers good cancer control and retention of bladder function. It does require a team approach and a high level of coordination among specialists for optimal effectiveness.
Chemotherapy’s Impact“When the tumor invades the muscle, there is the chance that certain cancer cells could have escaped, even though we don’t see them on scans,” said Kathryn Bylow, MD, the Medical College of Wisconsin medical oncologist who oversaw Gloria’s chemotherapy. “We know chemotherapy before surgery works, but nationally, we don’t find that all institutions offer it to the appropriate patients.”
Gloria had three cycles of chemotherapy from late 2010 to early 2011. It was a four-drug regimen given over four weeks per cycle.
“Chemotherapy for bladder cancer has some significant side effects and that’s why we reserve it for people who are otherwise healthy,” Dr. Bylow said. “Gloria did well for the first two cycles. The third cycle was challenging for her, but we supported her through it.”
Reconstruction ChoicesDr. Jacobsohn used the robotic approach to remove Gloria’s bladder in March 2011. He performed the surgery alongside Michael Guralnick, MD, Medical College of Wisconsin urologist, who reconstructed her new bladder. Before the surgery, Gloria had her choice of three methods to create a new bladder. Dr. Guralnick reviewed the options with Gloria, explaining the pros and cons of each.
“All three options involve taking a piece of intestine and using it in the urinary tract in place of the bladder,” Dr. Guralnick explained.
The most common procedure, called an ileal conduit, creates a stoma, similar to a colostomy, and urine drains continually into a bag worn outside the skin. The patient empties the bag whenever it gets full. It is the most common, because it’s the easiest to perform and the only option for some patients who may be too sick to undergo the other procedures.
The other two options – the neobladder and the Indiana pouch – each create a reservoir to hold the urine inside the body. Both reconstructive procedures require advanced training to perform safely and effectively.
Gloria chose the Indiana pouch, a procedure that uses a part of the ascending colon to form a reservoir or pouch to hold the urine.
“We attach the patient’s two ureters into the pouch to allow urine to flow into it; then, with a little piece of the intestine that’s attached to it, we bring the pouch out to the surface of the skin as a stoma in the abdominal wall,” Dr. Guralnick said. “The difference is that you don’t wear an outer bag. The patient inserts a catheter into the stoma to drain the pouch several times a day.”
Having robotic surgery also offers benefits.
“We have a very robust experience in doing this procedure robotically, and it’s critical to shortening recovery time compared to a standard open procedure,” Dr. Jacobsohn said.
Team ApproachGloria’s procedure was one of the most complex urologic surgeries a patient can have, according to Dr. Guralnick. Bladder cancer patients are often older than 70 and have conditions such as heart disease, diabetes and other health issues.
“These surgeries can have complications, and we know what to expect and when to intervene,” Dr. Guralnick said. “In fact, we get transfers of patients who have a serious complication after surgery done elsewhere.”
The team approach was important to Gloria’s care.
“The entire bladder cancer team works together to get to the goal of a good outcome,” Dr. Jacobsohn said.
Area’s Only Support GroupBefore her surgery, Gloria went to a bladder cancer support group meeting where people share their experiences and insights. The support group meets monthly and often has guest speakers.
“The support group provides hope,” said Heidi Stark, BSN, RN, nurse coordinator in the Prostate and Urologic Cancer Program. “We help clarify misconceptions and provide reassurance.”
A Positive OutlookGloria, a proud great-grandmother, continues to see her physicians for follow-up care, and is doing well today. She said she never stopped going about her life because of her diagnosis. Now she just has to plan ahead more, knowing she can go about four hours between bathroom visits.
She had great care at Froedtert & The Medical College, supported by strong family ties and a positive attitude.
Author: Dustin Kehrmeyer
Date: April 11, 2013
Last Review Date: April 16, 2013
Online Editor(s): Shannon Krause