If you are a patient with bladder cancer, it is important to know your choices for treatment. The type of treatment you receive may differ and as a result, your doctor may need to do a procedure called urinary diversion after the bladder is removed. #BladdersMatter #UrologyCareFoundation #BladderCancer

For more information on urinary diversion and bladder health, visit UrologyHealth.org.

What is Urinary Diversion?

When your bladder is removed or partly removed, you will need another way to store urine and remove it from your body because of cancer or an injury. Urinary diversion is a new way for your body to store and release urine after bladder removal.

Treatment Types
There are two types of urinary diversions: continent and non-continent.

Continent Urinary Diversion
For continent urinary diversion, your surgeon will make a pouch inside your body from part of your intestines to hold urine. With this type of diversion, there are two basic ways urine leaves the body: a catheterizable stoma or an Orthotopic Neobladder, where a surgeon makes an internal pouch much like a bladder to store urine. Ureters are joined to this new “bladder” to empty through the urethra. With a neobladder, you can pee from your urethra.

Non-continent Urinary Diversion
A non-continent urinary diversion, also known as ILEAL CONDUIT, involves linking the long tubes that lead to your bladder, also known as the “ureters”, to a piece of the small intestine that is brought to the skin. This is used to create an opening or stoma on the surface of the belly, usually on the right side of the abdominal wall. The urine leaves the body by the opening and is gathered in a bag for emptying. You will wear the bag under your clothes.

Urinary Diversion Recovery & Side Effects

Most people are happy with their urinary diversions and can develop a new routine.

Urinary diversions problems can happen, though. These may involve:
• changes in fluid and/or salt levels
• trouble placing the tube into the stoma
• problems with skin growing over the stoma
• basic problems that might result from an abdominal operation such as a blocked bowel, or urine or bowel leakage.

If you have a non-continent urinary diversion and need to wear a bag, you will still be able to take part in tough physical activity, as well as your regular daily routines. Most people can wear their normal wardrobe.

It is important you talk to your urologist about the types of urinary diversion to learn which one is best for you. You should talk about all the choices and feel sure in your treatment choice and the lifestyle changes it may bring.

Siamak Daneshmand, MD, Keck School of Medicine, Los Angeles, CA, discusses the role of CA 125, CA19-9 and CEA in predicting patient outcomes following neoadjuvant chemotherapy in muscle-invasive bladder cancer (MIBC) at ASCO GU 2021. The study found that elevated serum levels of these tumor markers prior to neoadjuvant chemotherapy was associated with upstaging of disease and was associated with worse outcomes. The study also indicated that these tumor markers may be utilized for earlier detection of recurrence, post-cystectomy. This interview took place during the 2021 Genitourinary Cancers Symposium.

Join BCAN and Dr. Michael Diefenbach to discuss some of the different ways that patients have to adjust to having their bladders removed, including common post-surgery issues.

Dr. Matt Mossanen discusses the importance of staying active with a bladder cancer diagnosis.

Join BCAN and Dr. Guru Sonpavde to talk what chemotherapy for bladder cancer is and how it works.

If you are a patient with muscle invasive bladder cancer, it is important to know your treatment choices. As part of your treatment, you may need to have some of your bladder removed. If this is the case, you should know your options for bladder preservation therapy. #BladdersMatter #UrologyCareFoundation #BladderCancer

For more facts about bladder preservation and bladder health, visit UrologyHealth.org.

What is Bladder Preservation Therapy?
Unlike Bladder Removal Surgery, Bladder preservation means you will keep all or some of your bladder. If you are considering Bladder Preservation Therapy, it’s best to first meet with a radiation oncologist to discuss your options.

Trimodal Therapy
Some bladder preservation therapy may involve trimodal therapy which combines surgery, chemotherapy and radiotherapy to give you the best possible outcome. .

Neoadjuvent Therapy
Neoadjuvent therapy is another option. Before your doctor removes all, or part of your bladder, he or she may try to shrink your tumor first with neoadjuvant cisplatin-based chemotherapy (also called NAC). This means certain drugs are first given as chemotherapy and then bladder removal is done afterwards. Chemotherapy will be given before your bladder surgery. This is called neoadjuvant chemotherapy, which is stronger than regular chemotherapy treatments.

About 6-8 weeks after neoadjuvent chemotherapy, you will have your bladder surgery. Your surgeon will cut away the tumor during a trans urethral resection of bladder tumor (TURBT) procedure.

After surgery, you can expect additional chemotherapy and radiation treatments. The goal of this blended approach is to shrink the tumor and also make the most of the chemotherapy that you are receiving at the same time.

Bladder Preservation Recovery & Side Effects:
You will have side effects after most Muscle Invasive Bladder Cancer treatments. However, there are things you can do which may help you feel better. If you smoke, get help to stop. If your doctor approves, you may also start exercising and eat more fruits and vegetables. Healthy choices may help you get better faster.

Some side effects from treatments include:
• Pain
• Change in bowel function
• Nausea, vomiting and diarrhea may be a side effects from your radiation.
• Urinary changes including urinary urgency and frequency, or sometimes blood in the urine
• Infections
• Hot flashes
• Sex and fertility issues

You should expect to see your doctor a lot if you have bladder preservation therapy. You will likely need many assessment and evaluation visits including surveillance through an endoscopy, a method which uses a scope to reach the urinary tract.

Your health care provider may also suggest a cancer support group or counseling to help. It is important you talk to your urologist about any questions or concerns you have about this treatment.