Removing and
Reconstructing
Bladders
Robotically
RAUL PARRA, MD
By BARBARA BERMUDEZ
While bladder cancer remains one of the most common cancers in the U.S., treatment
for the disease has not evolved much over the last half-century. Until now, that is.
Since the 1950s, most patients
who needed to have their bladder
removed—a procedure called a
cystectomy—ended up with an
ostomy, a bag outside the body that
collects urine. The ostomy severely
affected the quality of life for many
of these patients.
Currently, a few highly specialized
physicians, such as Dr. Raul Parra,
a urologic oncologist and the medical
director of the Holy Name Regional
Cancer Center, perform a robotically
assisted procedure to reconstruct
a bladder using tissue from the small
intestine. It avoids the need for an
ostomy.
Physicians started reconstructing the
bladder in the 1980s, but the difficulty
of the procedure and the challenges
with post-op care continue to
discourage the majority of oncologists
from performing it. About 80 percent
of patients who have a cystectomy do
not have their bladder reconstructed.
And when they do, the procedure is
typically done in large medical centers.
Dr. Parra is one of only three
physicians in the NY-NJ area who
perform the procedure robotically.
He also does cystectomies and bladder
reconstruction through open surgery
when necessary.
“In well-selected patients, bladder
reconstruction allows individuals to
not only urinate normally, but it also
gives them a significant improvement
in their self-perception and quality of
life,” Dr. Parra said. “These patients not
only function better but also are less
stigmatized by their cancer and readily
adapt to a normal lifestyle.”
More than 75,000 new cases of bladder
cancer are diagnosed annually in the
U.S.—2,500 of those in New Jersey.
Fortunately, the majority of patients
with the disease will have the tumor
removed while keeping the bladder
intact. In about 30 percent of patients,
however, the cancer has spread or is too
aggressive, and a cystectomy is needed.
For men, having a cystectomy means
removal of the prostate and seminal
vesicles with the bladder. In women,
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the ovaries, uterus, fallopian tubes and
anterior vaginal wall are also taken out.
Doing these procedures robotically—
through the navel in men and through
the vagina in women—results in a
dramatically smaller incision, less pain
and a reduced risk of infection. Not
all patients are candidates for robotic
cystectomies, however. Patients who
are elderly or morbidly obese may not
be eligible for reconstruction.
Robotically assisted procedures, which
began with treatment for prostate
cancer, have revolutionized cancer
protocols. Its technology allows
physicians to do more precise and
complicated procedures, from removing
plaque from arteries to excising tumors
in hard-to-access locations that might
otherwise be inoperable.
Dr. Parra, who performed the first
laparoscopic bladder removal in 1991,
said robotic surgery is “changing the
entire protocol for cancer treatment.
I believe 10 years from now, robotic
surgery will be the standard of care for
most cancer surgeries.”