WHEN Peter Baker found out his cancer had spread into the wall of his bladder, he was presented with two options.
Although both required the complete removal of his bladder, he could choose to have a procedure that would allow his urine to be collected in a soft plastic pouch attached to the outside of his body.
Or his doctor – urological surgeon Albert Tiu – could take about 50 centimetres of his bowel and use it to build a brand new bladder, with the help of a robot.
“I was sitting there going, ‘Riiiight, OK’,” Mr Baker, 58, said. “My partner and I just sat there, with our mouths hanging open, saying, ‘You’re going to do what?’
“I had never heard of anything like it. I just thought I’d be stuck with a bag for the rest of my life. Not that that would be the end of the world, but I am a pretty active person.
“I ride motorbikes and I swim, and I thought the bag was just going to be a bit of a hassle.”
It was in March that the Kahibah resident noticed there was blood in his urine.
“I had no pain, no discomfort at all,” he said.
Prompt investigation revealed he had stage 2 bladder cancer.
“I had a tumour about the size of a golf ball on the wall of my bladder,” he said. “Then they had to see whether it had spread into the wall of my bladder, which it had.”
Because his cancer was invasive, the complete removal of the bladder – a radical cystectomy – was required to prevent the cancer from spreading. He had an appointment with Dr Tiu while undergoing chemotherapy.
“Dr Tiu said with the neobladder, you end up looking perfectly normal. You don’t have a bag or anything like that,” Mr Baker said.
The “neobladder” offered him a better quality of life because it was “the next best thing to normal”.
“I am a school teacher as well,” Mr Baker said.
“Standing in front of a class, the bag would be visible under my clothes. You can disguise it a bit.
“For some people, that is the best option. But because I am relatively young and live a fairly active lifestyle, the neobladder was a much better option for me – I can always go back to the bag if I need to, but you can’t do it the other way around.”
Mr Baker underwent the complex procedure in June using the da Vinci XI surgical robot at Lingard Private Hospital.
“They say the robotic surgery allows for a quicker recovery, because of its precision, and because it makes smaller wounds,” he said.
“It is unbelievable. Five weeks ago I was in intensive care. Now, I am walking around, going to the gym, walking up and down the pool. I’m only doing light exercise, but I can cook a meal, I can do light housework, go out with friends. I feel great.”
Dr Tiu said bladder cancer affected about 3000 Australians each year, causing thousands of deaths.
Men were three times as likely as women to be affected.
Most bladder cancers started in the innermost lining of the bladder, but they became more dangerous once they grew into other layers of the bladder.
In those cases, removing the bladder was considered the “gold standard” treatment, and urologists had to create a new “urinary diversion” with a neobladder or ileal conduit (bag).
On average, Dr Tiu performs up to five neobladder procedures in Newcastle a year. Across Australia, he suspects there would be less than 50 performed each year.
“It is a major, complex procedure, only done for people who have cancer in the deeper layer of the bladder,” Dr Tiu said.
“The major advantage of the neobladder is that patients don’t have the urine bag protruding out through the abdominal wall, so they can function normally and still pee through the urethra.”
The procedure could be performed on both men and women.
“The take home message is that blood in the urine always needs to be investigated to make sure it is not bladder cancer,” he said.
“I have seen a few patients that had blood in the urine that was mistaken for a urinary infection and treated with antibiotics. Early detection is the key to being cured.”
Mr Baker said his out-of-pocket expenses were about $3500, which paid for the hire of the robot – not covered by his private health insurance.
“I would have rather not had to pay it, but it’s only money, and I now have a really good quality of life,” Mr Baker said.
“What else do you get for $3500? A crappy old second hand car? I’ve got a whole new bladder now.”