Someone presents with painless haematuria. Suspect bladder cancer until proven otherwise.
The following steps to be taken:
Determine the presence of the tumour. Do an intravenous urethrogram first to confirm any mass in the bladder as well as any that’s located along the urinary tract.
Followed by cystourethroscope under general anaesthesia. You get a better view by sticking in the scope.
Locate the site of tumour, the numbers present and appearance.
During the scope, do a biopsy. Then followed by transurethral resection of bladder tumour (TURT) if needed.
CT scan to determine affected lymph nodes and local invasion of the tumour.
Few choices available.
If bladder tumour is superficial (Ta, T1), then just by endoscopic diathermy.
If larger (T1, T2), then proceed to TURT.
If it is invasive (T2, T3), just remove the bladder by doing a cystectomy.
Complications of TURT.
Blood clots forming in the bladder after the procedure.
Those with bladders, of course you follow up with them with regular cystourethroscopy to detect any recurrence.
Those without bladders, there will be 2 choices:
To make a new bladder, or so called neobladder. Continence is retained. Uses colon or small bowel. Or… an internal reservoir is made to contain the urine, and is connected to the body surface. Urine is drained at regular intervals by catheter.
To create a passage for urine output without any storeroom. Incontinence. Ureters are implanted on the ileum. Ileum opens on to the abdominal wall. A urine stoma is created.
Intravesical epirubicin or mitomycin C reduces recurrent rates.
Cisplastin and methotrexate are useful as well.
Waseh… I tired liao. That’s pretty much it la.. got anything I add later la…