Second Surgery??? Is This Customary?

I got a copy of the report written by my physician after my neo bladder surgery and learned that a small sample of my urethra was viewed at pathology during surgery. I also got a copy of the pathology report and learned it was normal tissue.

Recently I had a follow up appointment (nine months post op) and had to endure some new procedure where they scrape an area within the urethra and send off to pathology and also for fish. My doc has been working on a method of isolating this area for fish and or cytology tests, saying this is an area they sometimes see recurrances of TCC, as the cells that line the urethra are the same as those that line the bladder, ureters and kidneys.

been looking around for articles on this very thing...and i know i'm just a layman but it seems to me that the Urethra is something that is taken into consideration at the time of surgery.........jjco.oxfordjournals.org/cgi/content/full/27/6/406
And yes Gracie....write down exactly what the surgeon is going to remove...thats a variable from institution to institution i have found.
Pat

I absolutely still have my urethra, although I was warned that if it looked like it might be cancerous that it would be removed. It was never suggested anytime that it might be removed at a later date.

I sure hate to second-guess a surgeon who has a far greater grasp of the entire situation than we ever could, but I also hate to see an additional surgery performed on an older man.

Tough choices and no good answers.

Debbie, I am so sorry that your father has to have another operation so soon after the r/c.

My father was told on the morning of his r/c that they would also take the urethra as the last time they were in there, there were abnormal cells or something, they said that It would add about another hour on to the r/c, I am not sure whether they will need to open your father up again, I know in dads case they did say they would cut around the end of the penis, but iam not sure whether they take the water tube (as dads surgern put it) from there or from in the belly.
For them to take your fathers kidney, I am guessing that the cancer had crept up the urita, this was also the case with my father, although they were able to get a clear magin & not take his kidney.

Prehaps they felt that keeping your father under for the additional hour or so would have been dangerous & that it would be benifical for him to come back to have the urethra removed, I realise that this is a set back but once it is removed it is one less area for the cancer to come back, try & keep your chin up & I will be thinking of you guys & also harleygirl & her family.
Regards,
Cathy

Harleygirl, thank you so much for sharing your Dad's experience. It has helped me to better understand the surgeon's rationale. I believe that the surgeon said that he would like to perform the surgery at the 3 month mark from the date of his last surgery which would be next month.

My Dad was so distraught when we spoke, that I didn't want to ask what a second surgery would involve. I only know that the surgeon told him it would be a two day hospital stay. Do you know if the urethra can be removed through a cystoscope or would another incision have to be made? Recovery time?

I am so sorry that your Dad is facing the same thing.

My father is 81 and is in a similar situation to your Dad's. The surgeon did not remove my Dad's urethra during his bladder/prostate removal last year either saying that the margins were clear and that Dad had been on the table so long (8 hours due to adhesions) that he did not want to keep him under any longer.

Now a year has passed and Dad has had problems with bleeding from the urethra since last July. His original uro kept telling him the bleeding would eventually stop. He finally sought a second opinion and had a polyp removed from his urethra last week, hopefully to stop the bleeding problem he has been having. The new urologist said there were abnormal cells in a saline wash he did of Dad's urethra but we don't have the pathology of the polyp back yet. The second urologist said it is likely that Dad will have to have the urethra removed and if it turns out this is the case, he will schedule Dad for the surgery quickly.

Dad's first uro wanted to take the urethra last month without performing any tests to justify this surgery. Dad didn't go for this and thus sought the second opinion. The second uro (who does over 80 cystectomies a year and also is a professor at a leading university hospital here in Texas) said that he usually does NOT take the urethra either UNLESS there is definite presence of cancer there when the bladder/prostate are removed. However, there is always the chance that there are micro-mets that won't show up until the disease has progressed. With bladder cancer, it is not out of the question that the cancer could spread through the prostate into the urethra.

Yes, I wish Dad's original surgeon had removed the urethra during his initial surgery. We weren't told then that he might have to have it removed later either. He had no positive nodes and did not have chemo either before or after surgery. Now he has an enlarged pelvic node and the second urologist wants to know how many nodes were removed during the bladder/prostate removal.

I don't want my Dad to have to endure more surgery either, especially at his age. He had to be under general anesthesia last week to get the polyp removed and didn't start feeling like himself for about four days. However, for my Dad, if the urethra needs to come out because of cancer or the chance of cancer, it must come out. With that said, I wish we had been told that he needed it removed earlier on in this process so he could have had it removed and not had to endure the bleeding problems he has had, not to mention all the scans and MRIs and x-rays, etc. We could have had all this behind us instead of facing more surgery now, a year later.

You can wait for symptoms to appear and then have the urethra removed, or listen to your surgeon and get it out now to prevent potential problems from developing down the line. Would there be time for your Dad to get stronger before the doctor wants to operate? I hope it all works out for both of our Dads.