Treating Bladder Cancer at Holy Name Medical Center: Removing and Reconstructing Bladders Robotically
 
Dr. Raul Parra, Medical Director of Holy Name Medical Center's Cancer Center
 

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 1950’s, 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 Medical Director of Holy Name Medical Center’s Cancer Center in Teaneck, New Jersey, 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 1980’s, but the difficulty of the procedure and the challenges with post-op care continues 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 performs 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, 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.

Robotic-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.”