By Pat Carragher - May 23, 2022
In July 2020, Doug Aman paid a visit to his urologist to seek treatment for pain in his bladder. What doctors initially thought was a case of overactive bladder turned out to be much worse when Aman started noticing blood in his urine a few days later. A second opinion found a tumor in his bladder, and an ensuing biopsy revealed it was high grade bladder cancer.
After six weeks of immunotherapy treatments, Aman opted for robotic cystectomy at Moffitt Cancer Center, a procedure that would completely remove his bladder. Surgeons also removed his prostate and the surrounding lymph nodes.
“I decided if I wanted to live long, I wasn’t going to roll the dice,” said Aman. “I decided to have the surgery done. It went so well that I was out of the hospital in three days.”
According to Dr. Roger Li, a genitourinary surgeon at Moffitt, there are three ways that surgeons can rebuild a patient’s bladder once it has been removed: an ileal conduit, ileal neobladder or continent pouch.
“There can be a lot of shock when we tell patients about what these procedures involve,” said Li. “It’s a double whammy learning about the diagnosis and then the treatment plan.”
Aman underwent an ileal conduit procedure, which is the most common of the three. Surgeons used part of his small intestine to create a passageway connecting the ureters, which carry urine from the kidneys to an opening created in the abdomen called a stoma. Urine then empties into a pouch outside the body, which must be regularly changed.
“I’m feeling well and doing just about everything I did before,” said Aman. “It’s just something you get used to. Sometimes you have to do things differently in your life, but it’s really no problem and it’s not dragging me down. I did have some trouble with leakage right at the very beginning, but after trying some different types of systems, we found one that works and I don’t have any problems at all.”
Another method is to create what’s called an ileal neobladder. This option involves a piece of the patient’s intestine being used to create a sack to hold urine, which is attached directly to the ureters and urethra. This allows the patient to pass urine in a similar way as before surgery.
The third method is a continent pouch where surgeons use a portion of the stomach or intestine to create an internal reservoir for urine. Patients can periodically empty the reservoir by inserting a tube into a stoma that was created during surgery.
According to the American Cancer Society, about 81,000 people will be diagnosed with bladder cancer this year. Nearly three-fourths of patients diagnosed with high-risk bladder cancer will recur, progress, or die within ten years of their diagnosis.
A new study published in JAMA shows robotic surgery reduced the chance of readmission by half (52%) and revealed a 77% reduction in prevalence of blood clots, a significant cause of health decline and morbidity when compared to patients who had open surgery.
Aman is approaching two years cancer free. He likes to spend his free time maintaining his home and yard. His surgery has not prevented him from keeping up with his routine repairs and landscaping duties.
His advice to someone who may be facing the same type of procedure and recovery?
“Just be patient,” said Aman. “It’s a lifestyle change, but it’s really something you get used to over time.”