The Impact of Bladder Cancer Survivorship
In the same way, we think of the trifecta of post radical prostatectomy as oncological outcomes, erectile function and continence, we should think of the ‘trifecta,’ of bladder cancer outcomes similarly encompassing oncological outcome, continence/urinary diversion complications and sexual function. This chapter covers the impact of bladder cancer survivorship.
Cystectomy has advanced to the point where, at its most sophisticated level, the procedure is robotic with intra-corporeal ileal conduit formation or even neobladder formation. Minimally invasive approaches have advantages such as reduced blood loss, postoperative pain, quicker recovery of bowel function and earlier convalescence. As such they contribute favourably interns of survivorship in bladder cancer. Firstly, patient time spent in hospital is reduced to allow greater enjoyment of slier return to health in the community. Secondly, long term complications with wound pain, herniation, incontinence etc. are less likely to occur with a lowered readmission and clinical intervention rate leading to better quality of (remaining) life and survivorship outside of a clonal environment.
In the same way, we think of the trifecta of post radical prostatectomy as oncological outcomes, erectile function and continence, we should think of the ‘trifecta,’ of bladder cancer outcomes similarly encompassing oncological outcome, continence/urinary diversion complications and sexual function.
Health-related quality of life and self-esteem have been improved following orthotopic bladder substitutions. These are the preferred method for urinary reconstruction post-cystectomy in younger, motivated and informed patients. Both in men and in women, orthotopic neobladder should be considered as often, the preferred choice, with excellent long-term oncologic and functional outcome. Now we can offer this procedure entirely minimally invasively and intracorporeally we should embrace the opportunity in terms of improving health related quality of life as well as survival.
Additionally, because bladder cancer patients tend to be of an older age group sexual counselling, is not often offered, but is an ‘ageist’ phenomenon that we can be potentially criticised for as urologists. These considerations should be taken forward by upcoming generations of surgeons who should embrace the new technology hand in hand with the principles of Survivorship.