8 years 10 months ago - 8 years 10 months ago#33704by mmc
Glad to hear you are going in tomorrow. See my post above about how they do the procedure. NO, they DO NOT go through your abdomen for this procedure. While the tumor may now be the 'size' of a golf ball it is not the consistency of a golf ball. You can tell what it's like in the video. They are not pulling a golf ball out through your penis. They are taking pieces and drawing them up through the cystoscope. It's soft tissue.
As Pat said, if he says he's going through your abdomen to do it, then get off the gurney and get the heck out of there because it means your guy doesn't know what the heck he's doing. I am sure that is not the case.
Almost all doctors come out to tell the folks waiting about how the surgery went. He doesn't really know much until the pathology report comes back but he can tell her how you did through the surgery and such. Just to be sure though, ask him if he can let your wife know after surgery. I'm assuming she'll be with you in the pre-op area when the doctor comes to see you prior the procedure.
At the very least, it is good to know the dang thing is out tomorrow. Hopefully, that will make you feel a little bit better about things.
Then the darn waiting starts for the pathology report. Waiting sucks!
If it is cancer, you then want to have the slides sent to a pathology department at one of the major cancer centers for a double check. Your urologist may even do that for you if you ask. If not, then it is easy enough to request your slides and send them yourself. You want to be absolutely sure of good margins all the way around the tumor and the reading itself in terms of stage and grade.
Then you need to get another TURBT in six weeks or so to be sure they got it all.
Before surgery you may want to ask him if he is planning to do a mitomycin wash. This is often done to help prevent any seeding of cancer cells in case it is cancer. They put it into the bladder directly. Since they are cutting the tumor and surrounding tissue you don't want cancer cells seeding any other areas of the bladder.
Write that down to bring with you so you don't forget. I've always found that morning of surgery isn't the best time for remembering things you wanted to ask and writing it down helps (if you can remember to pull the paper out of your pocket). I think I asked my wife to have the paper so I wouldn't forget.
Best of luck tomorrow! Let us know how it all goes once you are home.
Tom...ya got any track shoes? Put them on and run as fast as you can from any Uro who is going to remove your tumor from the abdomen. Turbs are just as important a surgery as any other and a golf ball size is difficult to remove but an expert bladder cancer surgeon knows what he is doing ..so i'm being redundant in telling you to get to Dr. O'Donnell at Iowa State. He's a top man in the field. Don't mess with this. I am in charge of the Bladder Cancer Police detail and i will come to your door.
8 years 10 months ago - 8 years 10 months ago#33698by mmc
They will just take it out in pieces. That cystoscope is more than just a viewer. It has a cutting tool that goes through it and it can pull stuff out. Your surgeon is the one to ask about that, not the preop physical guy.
Regarding golf ball size and speed of getting things done, I thought you might find this post from the Johns Hopkins bladder cancer site helpful:
December 15th, 2008 at 3:18 pm
My dad had a TUR three weeks ago for removal of a a golf-ball sized bladder tumor. He had been complaining of frequent trips to the bathroom at night for four years; his PSAs and DREs had been normal, so his physician wasn’t worried about a GU condition; thought he was just a light sleeper. UA during a physical exam showed blood…they treated him for a UTI and did a follow up UA….still had blood, so finally referred him to a urologist. Here’s my question….the urologist believes he got the entire tumor and did get clean margins. Could a tumor that had perhaps been growing for 4 years still remain noninvasive? Only 3-month cytoscopies are recommended. Is that a “normal” course of followup? Dad is 76. Thanks.
Dr. David Berman Says:
December 15th, 2008 at 7:59 pm
Golf ball-sized tumors (and larger ones) can be present for several years without invading, particularly if they are “low grade,” meaning they look less abnormal under the microscope than a high grade aggressive tumor. The followup sounds appropriate to the diagnosis, but if it’s o.k. with your dad, you should discuss diagnosis and management with the urologist until they make sense to you (see my earlier post at http://apps.pathology.jhu.edu/blogs/bladder/?p=10#comments). Examination of the specimen by a pathologist is an important part of the equation that guides therapy. You can read about it here: http://tinyurl.com/NYT2ndOpinion
If you want to see how it is done, here is a video of a TURBT procedure. They have EVERYTHING on youtube these days. There are various patient education videos. To find this one I just did a Google search on "TURBT" and then clicked on "videos". The example looks to be a pretty large tumor. As it is being cut, it is being sucked up the cystoscope.
So when I have the surgery how do they normally remove a golf ball size tumor from a bladder. My pre-op physical doctor said the urologist may remove it with an incision in the abdomen, is that normal?
To much time to think. Went to the American Cancer Society today and got some info, kind of depressing.
8 years 10 months ago - 8 years 10 months ago#33663by mmc
Pretty much any of the top 20 or so of the hospitals on that list (US News and Wolrd report link I gave you earlier in this thread) would be just fine for TURBT or 2nd opinion.
Memorial Sloan Kettering, Cleveland Clinic, Johns Hopkins, MD Anderson, University of Michigan are some names that come up a lot due to the top notch doctors and programs they have. Most of the top places have a team approach so your doctor isn't the only reviewing your case.
If you needed your bladder removed, then there is certainly a shorter list but 92% of tumors originate in the inner layer of the bladder and those are usually not treated with removal. Removal of the tumor and then treatment varies dependent on grade.
Hope you are able to get past whatever caused you to flunk so you can get this done and know one way or the other as soon as possible.