Urologists & Sexual Medicine Experts & treatments for bladder cancer located in Beverly Grove, Los Angeles, CA
Our top urologists at Comprehensive Urology offer a wide range of services regarding treatments for bladder cancer with advanced technology such as Da Vinci robotic surgery or TURBT. Highly specialized in treating urologic cancers with the most advanced techniques, our physicians are at the forefront of the field. We aim to provide excellent cancer control, while optimizing patient satisfaction and quality of life. We work with each patient in order to specifically tailor their treatment to their own clinical situation. One of the common diseases that we treat is bladder cancer.To learn more, schedule an appointment with us today.
The bladder, situated in the lower abdomen, has the function of storing and expelling urine. Urine travels from the two kidneys into the bladder via the ureters. With its elastic muscular wall, the bladder can both contract and expand to manage urine. Eventually, urine exits the bladder through the urethra.
Superficial bladder cancer is characterized by cancer restricted to the bladder lining, while invasive bladder cancer indicates cancer that infiltrates the bladder’s muscular wall or extends beyond it. About ten percent of transitional cell cancers originate in other parts of the urinary system, such as the ureters, urethra, and the renal pelvis, which is part of the kidney responsible for collecting urine.
Bladder cancer symptoms are vague and can sometimes mimic other urologic disorders. For this reason, our physicians conduct specific screening studies to aid in diagnosis. They follow a step-by-step approach to ensure precise diagnosis for each patient.
Approximately 90 percent of bladder cancers arise from the cells lining the urinary tract, known as transitional cell carcinomas.
In the United States, more than 60,000 people receive a bladder cancer diagnosis each year. Over the last two decades, the number of diagnosed cases in the country has increased by 50 percent. Bladder cancer is three times more prevalent in men than in women, yet women have a 30 percent higher likelihood of succumbing to the disease. Caucasians are diagnosed with bladder cancer about twice as often as African Americans, though African Americans and women are usually diagnosed with a more aggressive form of the disease.
There are many associated factors, called carcinogens, which increase the risk of bladder cancer. Smoking and tobacco use carry the greatest risk, contributing to over half of the cases. Smokers carry four times the risk of developing bladder cancer compared to nonsmokers. Smoking cessation does decrease this risk somewhat with time.
If screening reveals the presence of a tumor within the bladder, the subsequent step involves performing a bladder biopsy. This is usually a simple outpatient procedure utilizing endoscopic techniques (no skin incisions) to scrape the tumor from the bladder wall (called transurethral resection). When the tumor is superficial (confined within the lining of the bladder) and not aggressive (low grade) often this is all that is required to remove the cancer. However, when the tumor is more aggressive (into bladder muscle or high grade), more aggressive treatment may be necessary. Potentially a life-saving measure, a bladder cancer biopsy is extremely important in the treatment of cancer.
Once bladder cancer is found, a pathologist visualizes the cells under a microscope to determine its aggressiveness (low or high grade). The cancer is also staged based on where it has spread. Tumors that are confined within the bladder lining are considered Stage Ta or T1. Tumors that invade the muscle wall are Stage T2, and those that invade beyond the bladder are termed Stage T3 and T4.
When a bladder cancer is suspected on visualization of the bladder during cystoscopy, often the definitive diagnosis and bladder cancer treatment can be performed at the same time. When bladder cancer is found early (superficial, low grade, Stage Ta or 1), usually the tumor can be removed at the time of bladder biopsy using instruments through the urinary tract (termed transurethral resection – TUR).
Sometimes when there is more than one localized tumor, or when the tumor is higher grade or recurrent, the surgeon may give additional medications directly into the bladder through a catheter to help prevent the cancer from recurring or progressing.
At Comprehensive Urology, our aim is to provide our patients with excellent cancer control while maintaining their quality of life. Our surgeons, when clinically indicated, can perform cystectomy while preserving erectile function and urinary continence in men (prostate sparing cystectomy) and sexual function in women (vaginal wall sparing cystectomy in women). Our surgeons also are able to utilize the Da Vinci robot to perform robotic cystectomy in Los Angeles. Other treatment options that can be used alone or along with surgery in specific cases include chemotherapy and radiation.
The surgery, also termed robot assisted radical cystectomy, is performed by a surgeon utilizing the Da Vinci robot to enhance minimally invasive surgical techniques in a similar manner in which it is used for prostate cancer.
Transurethral resection of the bladder is a procedure in which bladder tumors are surgically removed from the bladder wall. The procedure is most commonly used to treat bladder cancer as the majority of bladder tumors grow on the superficial layer of tissue on the bladder wall, rather than deeper into the tissue. This allows the urologist to safely remove tumors or abnormalities as minimally invasively as possible while preventing the cancerous tissue from spreading.
TURBT is an ideal treatment option for patients with suspected bladder cancer compared to traditional operations that often involve removing the bladder through open surgery. TURBT allows patients to maintain their quality of life while still overcoming a potentially harmful disease. The board-certified urologists at Comprehensive Urology are committed to providing personalized care and minimally invasive treatment designed to preserve each patient’s quality of life.
A transurethral bladder tumor resection is typically performed at a hospital or surgical center under general anesthesia or local anesthesia. The procedure involves inserting a thin flexible tube with a small light and camera known as an endoscope through the urethra into the bladder. First, water will flow up the tube to help expand the bladder and provide the urologist a clearer view of the bladder wall. Next, the urologist will use a microwave instrument or laser to cut the tumor into smaller and smaller pieces that can be flushed out of the bladder with water. The tumor will then be sent to a lab to test for cancer, which will help the urologist determine whether additional treatments will be necessary.
Depending on the patient, the procedure can take between 15 minutes to one and a half hours. Fortunately, the operation typically causes minor side effects that clear up within a matter of days to two weeks. The most common side effects include:
Most patients will also have a catheter or small tube inserted into the bladder to assist with urination while the body recovers. The surgical site as well as the urethra may be slightly swollen for a day or two following the procedure, which may interfere with urination and cause mild discomfort or burning. Once the catheter is removed, patients may experience difficulty controlling urination and blood in the urine during the recovery period, so it is important for patients to get plenty of bed rest and drink plenty of water.
Patients who develop a fever of 101 degrees or higher or experience significant bleeding should seek medical attention to ensure that any blood clots are not causing complications.
TURBT is a minimally invasive procedure, however, it is important to understand that any medical procedure has a degree of risk. It is crucial to undergo TURBT with a trusted and skilled urologist who is not only board-certified, but also has a strong track record of success in performing the procedure. Potential risks include:
There is a risk with any medical treatment or operation. The team at Comprehensive Urology are dedicated to helping patients achieve the best possible outcome for their condition and strive to make patients as comfortable and confident as possible before any procedure. We take the time to ensure that our patients are well-informed about any treatment options and what to expect in order to provide the best comprehensive care.
The skilled urologists at Comprehensive Urology are proud to offer the latest and most advanced surgical methods available to treat bladder cancer. Depending on the severity of the disease, it may be necessary to remove all or part of the bladder, following by construction of a continence reservoir. With a robot-assisted cystectomy, patients will receive the best possible treatment with the best chance at a quick and seamless recovery.
To learn more about a robotic cystectomy or for a second opinion, contact the exceptional team at Comprehensive Urology in Los Angeles as soon as possible.
Using a robotic-assisted device, such as the da Vinci Surgical System, our urologists are able to forego the invasive traditional surgeries of the past in favor of the minimally invasive accuracy provided by the da Vinci. Other notable benefits include:
When all or part of the bladder is removed, patients will also undergo one of three different types of urinary reconstruction in which the patient can continue to allow urine to exit the body. These types of urinary reconstruction include:
Orthotopic Neobladder – A new bladder is created and connected to the urethra, allowing the patient to void urine as usual from the urethra.
Indiana Pouch – A type of continent urinary diversion in which a reservoir collects urine outside the body via a small stoma (opening). The patient does not require a urine bag or device, but must use a catheter to empty the pouch.
Ileal-Conduit – A type of urine diversion via a small section of the intestine, which allows the urine to empty through a small stoma (opening). Patients use an external urine collection bag or device.
The type of urinary reconstruction will depend on the patient’s health, severity of bladder cancer, as well as the patient’s preference.
When a bladder biopsy indicates aggressive (high grade) or invasive (into bladder muscle) bladder cancer, the situation calls for more intensive treatment. This typically entails bladder cancer surgery, which commonly involves surgically removing the bladder (referred to as cystectomy) and implementing urinary diversion to reestablish proper urine drainage.
In cases where aggressive and invasive bladder cancer necessitates bladder removal, the restoration of normal urinary drainage mandates a urinary diversion procedure. The choice of diversion technique varies based on individual patient factors. Different types of diversion may be performed for this purpose. These include
Ileal conduit: our surgeons use a small segment of the small intestine (termed the “ileum”) and attach the ureters to one end of the segment. The other end is connected to the lower abdominal wall to allow urine to exit into a small drainage bag (termed a urostomy) through a nickel size opening. It is considered the least complicated of urinary diversions
Neobladder: Our surgeons create a new bladder (“neo-bladder”) using a longer segment of the intestine. They reconstruct the intestine into a spherical shape that resembles the natural bladder. Subsequently, they connect this newly formed bladder to the urethra, enabling patients to urinate in a more natural manner without requiring external devices like a “bag.” When combined with a prostate sparing cystectomy, this approach offers patients a new bladder, complete urinary control, and the preservation of erectile function.
Continent reservoir: For eligible patients who cannot have the neo-bladder connected to their urethra (i.e. invasive cancer into the pelvis, previous extensive pelvic irradiation), but prefer not to have an external “bag”, our surgeons use the intestine to create a new bladder (neo-bladder) and create a continence mechanism for it. It is the connected to the abdominal wall. Patients then drain the pouch every several hours with a catheter, so no permanent external drainage bag is used.
Chemotherapy can be utilized in multiple ways for the treatment of bladder cancer. When a patient has a cancer that is highly aggressive, chemotherapy can is sometimes be advised by a bladder cancer surgeon in Los Angeles (either before or after surgery) to help decrease the chance of spread (metastasis). Chemotherapy also is used to treat metastatic bladder cancer (cancer that has spread to other organs).
Although surgery and chemotherapy are considered the main treatment for advanced bladder cancer, simultaneous chemotherapy and radiation can be used as an alternative to try to save the bladder (bladder sparing therapy). This type of treatment is only about 40% effective in controlling bladder cancer.
When a patient has been diagnosed with aggressive or invasive bladder cancer, it is often necessary to take an aggressive approach to eliminating the disease and preventing it from spreading to the rest of the body. In most cases, advanced stages of bladder cancer are treated by surgically removing the bladder (a procedure called cystectomy) and restoring urinary draining through urinary diversion. In order to help maintain normal urinary function, rather than relying on an external drainage bag, a new bladder (Neobladder) is constructed from a segment of the small intestines.
Overcoming a serious illness such as cancer can be intimidating and overwhelming, but it is important to work with a skilled medical team who will not only fight to protect your health and quality of life, but also listen to your concerns and needs.
Comprehensive Urology strives to ensure that patients can maintain as much normal function as possible while still eliminating harmful diseases such as bladder cancer.
A Neobladder is a portion of the patient’s small intestine that is reconstructed and joined to the ureters, which bring urine from the kidneys to the new bladder, and the urethra, which allows the urine to exit the body. The section of the small intestine is formed into a small pouch that mimics the reservoir function of the bladder and helps prevent urine from backing up and causing infection in the kidneys. However, patients will have to adjust to the temporary and permanent changes that may happen to their body as a result of the surgery, such as an initial lack of muscle control over the Neobladder compared to the natural bladder. The urologists and nursing staff at Comprehensive Urology and Cedars Sinai Medical Center will work closely with the patient to ensure that the adjustment is as comfortable and seamless as possible.
Since a cystectomy and Neobladder procedure often involves removing surrounding pelvic organs, such as the prostate in men, and the uterus, fallopian tubes, and ovaries in women, the recovery process will vary from patient to patient. Patients may need to spend up to two or three weeks in the hospital to avoid any possible complications as well as to provide assistance with the process of using the Neobladder.
It may take several months for patients to regain their strength and return to normal activities, such as driving, going back to work, and exercising. During the first few weeks at home, patients will have a catheter to assist with urination as the body continues to heal. After the removal of the catheter, medical professionals will provide patients with instructions on how to utilize the new bladder. In the beginning, individuals will need to empty the Neobladder every one to three hours. This frequency will gradually increase as the bladder capacity grows.
In some cases, patients may have to use a catheter each time they need to empty their bladder in order to ensure that there is no residual urine remaining. Failure to fully drain the bladder could lead to urinary tract infections or the formation of kidney or bladder stones.
The small intestine used to create the Neobladder will naturally secrete a thick mucus that will be present in the urine. It will be necessary for the patient to regularly flush the bladder to cleanse the mucus from the bladder and prevent blockages.
What are the Advantages and Disadvantages of a Neobladder?
As with any surgical procedure, individuals should consider both advantages and disadvantages, particularly when contemplating the complete removal of an organ. The Neobladder is preferable for many patients because it most closely mimics the normal urination process and protects the kidneys from infection or kidney stones. However, recovering from the Neobladder operation can be lengthy and result in urinary leakage and regular self-catheterization.
It is important to discuss your concerns and whether you are a viable candidate for a Neobladder with the skilled urologists at Comprehensive Urology.
An ileal conduit, also known as a urostomy, is a type of urinary diversion technique in which a urologist creates a system of urinary drainage with a section of the patient’s small intestine. This procedure is one of several treatment options for patients that must undergo a cystectomy or total removal of the bladder due to muscle-invasive bladder cancer, recurrent bladder tumors that do not respond to transurethral resection or chemotherapy, chronic inflammation of the bladder, or birth defects.
This procedure is permanent and life-saving, particularly for patients facing advanced stages of cancer. Choosing to under an ileal conduit is not a decision to take lightly and the expert urologists at Comprehensive Urology strive to help patients achieve the best possible outcome for their condition. If a patient is a valid candidate for ileal conduit, our team will work tirelessly to preserve the patient’s quality of life and physical function.
An ileal conduit redirects urine from the kidneys to an external bag located on the outside of the abdomen. Surgeons sew a section of the small intestine called the ileum to the ureters from the kidneys to create the urinary diversion. This connection results in a small opening formed through the abdominal wall, known as a stoma. After the surgery, a small plastic bag is affixed around the stoma to collect urine from the ureters.
Patients will assume the responsibility of cleansing and safeguarding the stoma, which can be sensitive to bacteria. They will also care for the tissue surrounding the stoma, which is exposed to caustic urine. Monitoring urinary flow and regularly emptying the urinary bag are important tasks for patients.
Following a cystectomy and ileal conduit operation, patients will need to spend about a week in the hospital to ensure professional care and prevention of complications. Full recovery can take up to six to eight weeks, during which patients will receive regular checkups to monitor how well the patient is healing and adapting to the stoma. In many cases, surgeons opt to remove additional pelvic organs during a cystectomy. This measure ensures the prevention of cancer cell spread. For men, this often means removal of the prostate and lymph nodes, and for women it means removal of the uterus, ovaries, falopian tubes, and even a part of the vagina. At Comprehensive Urology, our team strongly believe in preserving as much healthy tissue and bodily function as possible and may take action to prevent removing surrounding pelvic organs.
Ileal conduit urinary diversion presents an ideal choice for individuals undergoing a cystectomy. This procedure is both safe and effective, requiring less time compared to other, more intricate surgeries. Furthermore, the stoma and urinary bag spare patients from the occasional self-catheterization often necessary with other procedures, like a Neobladder.
The few disadvantages of an ileal conduit include having to care for an external bag that collects urine and may leak or cause odors. Many patients face the psychological impact of a sudden change in body image and must learn to adapt to the new responsibilities of caring for a stoma and urinary bag. One of the main risks associated with an ileal conduit is the potential for urine collecting in the kidneys, which can lead to kidney infections, stones, and organ damage.
There are pros and cons to any type of urinary diversion technique and it is important to discuss your options and concerns with a highly trained and experienced urologist, such as Dr. Kia Michel. Undergoing an organ removal and creation of a stoma is a major decision, but the dedicated team at Comprehensive Urology take the time to help patients make an informed decision that they can be comfortable and confident with.
What is a cystoscopy?
Cystoscopy is an examination utilized to assess abnormalities within the bladder itself. It frequently forms part of the evaluation for patients experiencing blood in the urine (hematuria). Performed with anesthetic, this simple 5 to 10 minute procedure involves inserting a camera attached to a thin, flexible tube into the bladder through the urethra. This allows for direct visualization of the bladder’s lining.
What are the side effects of cystoscopy?
The vast majority of patients tolerate the procedure very well. Side effects can include minor bleeding or burning with urination (which is self limited), temporary irritative urinary symptoms, urinary infection (minimal risk due to the administration of a single antibiotic at the time of the procedure), and the small risk of scarring. The procedure entails no increased risk compared to the placement of a simple urinary catheter for bladder drainage. The side effects are self limited and tend to resolve within 24 hours of the procedure.
Are there any limitations after the procedure?
After a cystoscopy is performed, there are no activity or dietary restrictions. However, if your procedure involves the use of intravenous anesthetic, certain restrictions might be applicable due to the effects of the anesthetic on that particular day (i.e. driving restrictions).
How is a bladder biopsy performed?
Typically, this procedure is a straightforward outpatient process that uses endoscopic techniques (without skin incisions) to scrape the tumor from the bladder wall, a procedure referred to as transurethral resection. When the tumor is superficial, limited to the bladder lining, and not aggressive (low grade), physicians often find this to be sufficient for removing the cancer.
To schedule an appointment, call our office or book an appointment online. Learn more about bladder cancer near me today.