SUBTOTAL CYSTECTOMY AND TOTAL BLADDER REGENERATION IN TREATMENT OF BLADDER CANCER

The subtotal operation is preferred even in patients with cancer so far advanced that the operation must be regarded simply as palliative, for it removes a mass that is a source of pain and hemorrhage.

Abstract

Three types of operation are particularly important in the treatment of cancer of the urinary bladder: transurethral resection, suprapubic segmental resection (which may be subtotal), and cystectomy. Considering the difficulty of complete extirpation of the lesion by transurethral route and the disadvantages of cystectomy to the patient, the authors are convinced that the former is too likely to prove inadequate and the latter unnecessary and too radical. In their experience nearly all of the bladder can be removed by the technique of suprapubic segmental resection without depriving the patient of the possibility of ultimately regaining good vesical function. The operative mortality is not greater in proportion to the amount of bladder wall removed, for the remaining portion has the ability to regenerate all the layers of the normal bladder. Such regeneration occurred in all patients, and bladder capacities up to 410 cc. were attained. The subtotal operation is preferred even in patients with cancer so far advanced that the operation must be regarded simply as palliative, for it removes a mass that is a source of pain and hemorrhage.