Artificial Bladder (From Intestines)
In some types of bladder cancer, the disease can only be treated by removing the bladder.
As mentioned in the bladder cancer section of the site, if the bladder cancer spreads deep to the bladder muscle layer, if there are many large tumors close to the muscle tissue, or for patients who are not responsive to TUR Tm surgery and BCG treatment, metastasis possibility is very high. In such an adverse situation for patient life, the “Radical Cystectomy” surgery, where bladder, prostate, seminal vesicles and lymph tissues around large veins are removed, must be performed.
How will patients urinate after the bladder is removed?
There are many methods in urology for this, however the most frequently used on is the “ILEAL CONDUIT” method where two urinary tracts (ureters) are connected to the end of 12-15 cm long small intestines and connecting the other end of the intestines to the stomach skin. Urine coming from ureters (urinary tracts) to this intestine piece fills into this bag and patients empty the bag as it fills. This bag is required to be changed once in every 2-3 days.
An important alternative to this traditional method is the “ARTIFICIAL BLADDER=BLADDER FROM INTESTINE” method called “ORTHOTOPIC BLADDER” which is being applied for 15 years in developed countries and we successfully perform this procedure for the last 12-13 years. In this surgery technique, a new bladder is created by using either large or small bowel or both. I’ve been performing the technique that uses the small intestines for the last 12-13 years as a result of the education I’ve received in Switzerland.
In this operation, a 50 cm long intestine is separated and its shaped into a “sphere” by folding several times in order for its shape and functions to be similar with the bladder and be able to fulfill required tasks. Therefore, its capacity, inner volume, is expanded in order to store urine. Two ureters (urinary tracts) are connected to one end of the bladder made from sphere-shaped bowels (anastomosis), other end of the bladder made of intestines is connected to the external urinary tract.
The incidence of urinary incontinence in the day following this surgery depends on the absence of damage to the urinary retention valve (sphincter) during the removal of the urinary bladder, and if the surgeon is highly experienced such problem will not occur.
A normal healthy person has a urinary bladder capacity of about 400 ml, which means that a normal healthy person can hold urine to this level. Patients who have undergone artificial bladder (bladder from intestines) surgery reach this bladder capacity in about 4-6 months.
THE MOST IMPORTANT ADVANTAGE OF BLADDER FROM INTESTINES (ARTIFICIAL BLADDER) is “preventing reduced quality of life” and “being socially acceptable”.
Surgery, performed by experienced surgeons using proper technique, must provide the patient with following:
•    Patients must have urinary incontinence during the day
•    They must urinate with ease
•    Their artificial bladders must be able to be completely emptied and no urine must remain inside
•    No growth must be present in the urine culture
Advantages of Artificial Bladder
•    Socially acceptable
•    It is not easy to make such a big surgery decision if the necessity to remove the bladder has occurred, and this delay affects the life of the patient very adversely.
If bladder from intestine operation will be performed after the necessity for removing the bladder is revealed with the diagnosis as a result of multi-center studies conducted in the most important Urology clinics of USA and Europe, average decision making-time is 3 months, whereas the acceptance duration of carrying a bag in the stomach is 15 months after the recommendation. This significant gap may be costing patients their lives.
•    In the advanced bladder cancer, relapse rate of this disease in external urinary tract in the long term after the surgery is 2.8% in artificial bladder (bladder from intestines), whereas this rate goes up to 11.2% in patients with urinary bag. This is likely to be related to preservative, preventive effect of the secretions formed by the intestines.
•    In high-risk TI G3 (TI High Grade) bladder cancers, if the tumor is widespread inside the bladder, this requires close follow-up with cystoscopy, TUR Tm surgery in every 3 months; in addition, there may be adverse effects of BCG inserted inside the bladder.
Such patients are more likely to decide on this technique.
Lifetime of Artificial Bladder
Another subject raised by our patients is whether these new bladder constructed from the intestines have a long life time.
There is no such concept as the life time of artificial bladder. As long as the patient is alive, he or she will have no problems due to the newly constructed orthotopic bladder. The first surgery we have done so far in this regard was 13 years ago. Therefore we still see our first patient and there are no problems.

In the cystoscopic (endoscopic) imaging performed to our patient, who had undergone Bladder From Intestine Surgery, 3 years after the procedure, capacity of the artificial bladder is shown to be 500 ml and it is very difficult to differentiate from the bladder of a healthy person.

Bladder cancer is the most common cancer of the urinary tract. It is the most common type of cancer with 7^th place in men while 17^th place in women. The incidence of the disease is 9/100,000 in men, 2/100,000 in women. It may vary according to the risk factors exposed in each country. Although it is seen often over the age of 70, the onset age of the disease has already been down to the age of childhood in recent years.

The urinary bladder is an organ within the pelvic bone that gets charge involved in the storage and disposal of the urine with expansion capability. There are layers in different structure in the urinary bladder wall; superficial layer which is in contact with urine in the innermost part, muscle layer in the middle part and fibrous layer in the outermost part. The treatment is determined by the diffusion of cancer in these layers. So, cancers only settled on the inner surface layer of the urinary bladder are with better course, while the danger is increasing towards the fibrous outer layer and the type of the treatment changes.

90% of bladder cancers arise from its own internal layer, transitional epithelial cells, that has expansion capabilities as pathological structure. 70% of these are on the superficial layer, while 30% is more advanced and spread to the muscle layer. The spread of cancers that has spread deep into the walls of the urinary bladder spread to surrounding organs by regional contact and metastasis can be more rapidly and dangerously.

Risk factors

Risk factors varies according to different types of cancer and personal characteristics and habits play significant role. Smoking, genetic characteristics from family and exposure to carcinogenic factors are among the important factors.

Smoking: It is considered to be among the most important risk factors. 50% of patients that suffer from bladder cancer are smokers. Bladder cancer risk is increasing too much, because aromatic amines and hydrocarbons in tobacco are excreted from the kidneys after mixing with blood.

Occupational exposure: It is observed as occupational exposure in those working in the paint, metal, leather, rubber, textile and oil industry. Because, workers of these industries are exposed to aromatic amines. In addition, significant carcinogenic substances has also been identified in some permanent hair dyes

Genetic characteristics: Several carcinogenic substances are filtered by the kidneys and concentrated in the urine. It is found in the performed studies that, some people detoxify these carcinogenic substances in lower rates than others and exposed to carcinogens in higher rates depending on genetic structure.

Chronic bladder problems: Also, long-term bladder infections, bladder and kidney stones leads to bladder cancer due to chronic irritation in the performed studies.

Cyclophosphamide therapy: It is also detected that the chemotherapy medication called cyclophosphamide (Cytoxan) used in the treatment of lymphoma increase the risk of developing bladder cancer.

Symptoms

The most important symptoms are observing bleeding with urine, burning sensation during urinationand pain in the bladder region. Patients with one of these symptoms must admit to a physician.

Treatment

Superficial bladder cancers are only found in the mucosa of the urinary bladder and invaded to the muscle. Tumor tissue is taken out via TUR operations performed by entering from the urinary tract. If pathological examination revealed high-risk superficial bladder cancer, the treatment is continued with intravesical drug administration and control cystoscopy is performed at 3-month intervals.

If the cancer is spread to deeper to the bladder muscle complete removal operation of the bladder, together with creating a new urinary bladder from the intestines or a surgery in the form of connecting a part of the intestine to the urinary tract called ureter coming from the kidney and open directly with the abdominal skin or radiotherapy and / or may chemotherapy may be required.

A multidisciplinary approach is performed for bladder cancer in Liv Hospital. Common diagnosis and treatment are planned by urology, medical oncology, radiation oncology, pathology and radiology clinics.

Some general metabolic and environmental factors in the foreground in the formation of kidney stones. Heredity, nutrition, gender, age, geography, climate and occupational features are included into the factors that influence the formation of stones.

Stone disease is present in at least 25% of those who have stone disease in the family, so we can talk about familial predisposition. Stone disease is seen in men 3 times than women. This is because the estrogen hormone in women increases the level of citrate, which is the preservative in the urine, and reduces the amount of urine oxalate involved in stone formation.

It is seen more often in mountainous, desert and tropical regions. The risk of stone disease is 2-3 times higher in some of our regions. It is more common in Southeastern Anatolia, Mediterranean and Black Sea regions. It is most common in Diyarbakir and Sanliurfa in Turkey. Therefore, geography is a factor affecting the frequency of occurrence of the stone as well as the type. The risk of stones increases during the summer months. Contact with sun also increases the amount of calcium in the urine by increasing the synthesis of vitamin D.

The frequency of stone disease is increasing in those especially working in hot environments. For example; agricultural workers, outdoor workers. The risk of stone formation is increasing in employees of sedentary work (office work), in immobile or bedridden people.

Stone disease usually allows you to admit to a physician by revealing a complaint. The most common occurring symptom is pain. Pain can be in kidney, as well as in the groin or lower depending on its settlement of the stone in the urinary tract. Sometimes complaints similar to mild muscle pain may be present in the lower back and back. Everyone trying to pass the urinary tract stones knows that this period may be very painful. The cause of pain is usually the stone blocking the urinary tract. The sudden and nearly complete blockage causes severe stone pain. Kidney stones can lead to symptoms such as nausea, vomiting, blood in urine, sudden deterioration in urination habits other than pain. These include frequent urination, inability to relax by urination, burning during urination, decrease in urine viscosity. There are also cases that kidney stones do not give any symptoms. Therefore, to have a regular health check-ups made are important in terms of the detection of stones that do not give any symptoms.

The presence of stones in the kidney may significantly disrupt one’s quality of life by leading to severe pain or other symptoms. In addition, one of the most important risks that untreated kidney stones can cause is infection. Symptoms such as high fever, chills, shaking may occur in the presence of infection. This situation occurs more in situations that the infection effects kidney. Kidney infections can damage kidney tissue when emerged. The emergence of infection can also complicate the stone treatment. Therefore, it is wise to make the treatment plans in the presence of stones before the kidney infection is developed. If the stone is left untreated in the kidney or urinary tract for a long time another risky situation it might create is kidney dysfunction. We may often encounter kidney or urinary tract stones leading to the loss of the entire kidney due to not being treated in time.

The detection of cases that increases susceptibility and to take measures against it is needed, because kidney stone disease can be repeated frequently. In some cases, tendency to kidney stones increases.

1. The disease starting at an early age (under 25 years)
2. Those who have frequent urinary tract infections
3. Some stone types (infection stones, uric acid or urate stones so to say those with gout disease)
4. Children and adolescents
5. Genetic diseases (such as cystinuria, primary hyperoxaluria, renal tubular acidosis type I, xanthine, cystic fibrosis)
6. Hyperparathyroidism (excessive work of parathyroid glands)
7. Intestinal diseases and previous gastrointestinal surgery (malabsorption from the bowels, previous gastrointestinal surgery, Crohn’s disease, colitis and certain metabolic diseases).
8. Family history
9. Having only one kidney
10. Having excessive bilateral stone load
11. Remain of a stone part in the kidney after stone treatment
12. Some medications (such as excessive calcium and vitamin D supplements, some diuretics, antacids, goiter drugs)
13. Anatomic abnormalities in the kidneys or urinary tract
14. Lack of citrate in the urine (citrate has a preventive effect on stone formation)
15. Changes in the pH of urine (too much rise or fall)

In which cases intervention is needed?

Interventional treatments are planned when the patient cannot pass the stone whatever the size is within a period of 3-4 weeks or there is a stone detected as 7-8 mm in size and over when diagnosed. Stones that are not blocking the urinary tract, not causing any discomfort to the patient, settled in small chambers in the kidney called the calyx are followed for a while; but the general opinion is in direction that choosing one of the least risky methods for such stones and treating patients is more accurate.

Kidney cancers originating from the cells of the kidney constitute 2-3% of all body cancers. However, they are important because they are a serious type of urological cancers in vital aspects. It is seen in 2 women against in every 3 men. Although it is a disease of the ages of mostly 60-70, it is also seen in young people. Family transition by 2-3% is also observed in the performed studies.

The incidence of kidney cancer increased with 3-4% per year via increasing use of examinations such as ultrasound and computed tomography since the 1970s and the opportunity of early diagnosis is provided.

The most important risk factor that lead to kidney cancer is considered as smoking. It is detected that 20-30% of those catches the disease are exposed to any of tobacco products. Besides, excessive weightand high blood pressure are also two other important factors detected. Many kidney tumors can grow without giving any symptoms, because the kidneys are localized in the posterior intra-abdominal region. 50% of kidney cancers are diagnosed incidentally in a test performed for other purposes.

The disease may manifest itself as blood in the urine, pain or spread to the other organs after tumor growth. In addition, weight loss, fever, nausea and weakness complaints may also be observed.

Surgical intervention performed with early diagnosis is very important in kidney cancers because it provides complete recovery to the disease. Sometimes it can be diagnosed with bleeding in a simple urine examination, an ultrasound computed tomography (CT) or magnetic resonance imaging (MRI) performed.

Types of Kidney Cancer

There are more than one million units capable of producing urine in each kidney. We call each of these units as the nephron. Each nephron is connected with a microscopic renal tubule; each tubule is linked to the tubules coming from other nephrons. Tubules carry urine to the middle part of the kidneys that we call pelvis through the collector channels. If kidney cancer develops from these tubules these tumors are called “cortical tumors”, while called “transitional cell cancer of the urinary tract” (urothelial carcinoma, transitional cell carcinoma) if it develops from the part we call as renal pelvis where urine is collected.

It also is needed to remember that all the masses in the kidney are not cancer, kidney cysts in the kidney that can often be diagnosed benign by imaging techniques and non-malignant tumors that we call angiomyolipoma.

Also, metastasis to kidney from cancer of other organs (such as breast, lung, skin) may occur. Again, lymphoma is one type of the cancers that we encounter in the kidney. Their treatment is also performed by similar methods used in the treatment of original cancers

Symptoms of Kidney Cancer

Kidney cancer usually grows insidiously without giving any symptom. The discomfort given by tumor growth is sometimes diagnostic, while sometimes the following complaints may be observed depending on the progression of the disease:

• Blood in the urine
• Backache
• Spread to other organs
• Unexplained weight loss
• Fever not associated with cold or flu
• Tiredness
• Nausea
• Edema in the legs due to the absence of adequate disposal of fluid from the body
• Weakness

Treatment

In Liv Hospital, the most appropriate treatment for patients who were diagnosed with kidney cancer is selected in joint committee made by urology, medical oncology and radiation oncology clinics. Early diagnosed patients can be treated by removing only the tumor in that kidney via robot-assisted laparoscopy or direct laparoscopic method. If the tumor has grown in size that in cannot be removed alone, then again the kidney must be removed with surrounding tissues via laparoscopic or robotic method.

Testicular cancer constitutes 1% of all male cancers and it is the most common type of cancer among 15-35 years old. Any cause of the disease about personal habits, lifestyle and activities is unknown. However, there is a significant risk of cancer in the case called undescended testicles that testicles are not completely descended to the bags and those with cancer in their other testicle.

The most important symptoms emerge as pain, swelling in the testicles or stiffness. A multidisciplinary approach is performed for testicular cancer in Liv Hospital. Common diagnosis and treatment are planned by urology, medical oncology, radiation oncology, pathology and radiology clinics. Recovery is ensured in many early stage testicular cancers after the operation carried out by our experienced urologists, while radiotherapy is performed with the most modern equipment and chemotherapy is performed in the most beautiful surroundings in the necessary cases.