Neobladders: Any urologists around?

[Adam]

My 67yr old father has been diagnosed with Bladder Cancer. After extensive bladder scrapings and biopsies, they've concluded it's Stage 3 and into the muscle wall of his bladder.

He's been given two options:

1) Chemotherapy, 3-monthly bladder scrapings and radiation therapy, however he's been told the the survivability isn't great and to expect around 3-5yrs.

2) Have the entire bladder, prostate and lymph nodes removed, take on a bag. Major surgery, approx 7hrs worth. He's been told to expect a 95% survival chance. This at first sounded alarming, but while Dad's attitude towards all of this has been amazing, I'm concerned that there may be an underlying psychological effect. I know how I'd feel... Anyway, we read up on Neobladders (an artificial bladder, constructed out of the patient's own small intestine and carried internally, voiding thru the usual channel) and so he asked the surgeons about it, who seemed mystified.

It turns out that "Neobladder/Urinary Diversion" isn't a very common procedure in Australia. So, Dad's chosen to take Option 2 and they've scheduled him in for surgery on May 22. He's upbeat about it and pragmatic about the prospect of dealing with a bag.

In the meantime, the surgeons in turn have researched it themselves. They believe he's a good candidate for the surgery and are now keen to attempt it, given Dad's circumstances (relative health, attitude etc). As it's uncommon here, there are apparently quite a few notable local surgeons keen to get involved - heads of department, various hospitals and universities. This worries me a little, as there are surely both pros and cons involved with being an experimental guinea pig.

Can I ask: how common is it in the USA and is it generally successful?

[Paco Anton]

Adam,

My father now 71 was diagnosed with bladder cancer some 6-7 years ago and went the neobladder way. He had his bladder removed and a bladder made from intestine pieces. Now the cancer is 100% gone and he is as active as ever, playing golf on a semi-daily basis, taking his granchildren to the park, playing bridge and so on.

The downside of the neobladder is that the patient loses control over the bladder muscles and managing the needs to go to the toilet are somewhat challenging. My father now carries an adult diaper when he is not going to be near a toilet for some time (i.e. in the middle of a golf round).

His doctor offered him the possibility of installing a valve to mechanicaly control urine flow but he chose not to have it done as he felt that his lifestyle was not significantly affected and did not want another surgery.

When chosing his options my facher shopped around until he found the best doctor available, even going outside his medical insurance and social security. In retrospective the procedure was 100% successful.

I do not have much more information about the procedure but I do not feel it to be experimental.

[Laneco]

Our grandma Mary opted for the chemo/radiation/scraping bit.

She died cancer free - it was the cure itself that killed her. Put her into a downward spiral that was best described as a free fall.

At this stage of cancer, at that stage of life, the bag is not such a bad option. I wish that gma Mary had chosen it.

angela