Invasive Bladder Cancer Requires Radical Treatments, says Urologist Paul Perito MD

Paul Perito MD

Paul Perito MD

A radical cystectomy can remove most cancer cells but it is not without major risks, according to Paul Perito MD.

According to Paul Perito MD, a radical cystectomy is an operation used to remove the bladder, as well as any surrounding organs that are affected by carcinogenic cells. Paul Perito MD, a Coral Gables, Florida-based urology specialist, explains that the procedure has been around since the 1800s but it was not until the mid-20th century that the basic principles of surgery were described in medical texts. According to Paul Perito MD, the procedure was updated in 1987 to accommodate a nerve sparing dissection that would preserve sexual function. Paul Perito MD notes that the average hospital stay for radical cystectomy is around seven days. Although this is considered a major surgery, advancements in medicine have lowered the instance of intensive care post-operatively.

According to Paul Perito MD, bladder cancer is either a non-muscular or muscularly invasive disease. Transitional cell carcinoma (TCC) is the most prevalent form of bladder cancer. Instances of TCC rose rapidly from the mid-1980s to the mid-1990s and in 2008 an estimated 14,000 people died of the condition, reports Paul Perito MD. Bladder cancer is more common in men than women, and the diagnosis rate is higher among Caucasians than African Americans.

There are specific environmental risk factors generally associated with bladder cancer, notes urologist Paul Perito MD. Smoking and exposure to certain paints, dyes, and solvents, as well as prior radiation therapy are all common in patients presenting with TCC or other less common forms of bladder cancer. Since TCC can progress at varying speeds, early detection is imperative to control the spread of carcinoma beyond the lining of the bladder, says Paul Perito MD. Low fluid intake, treatment with certain drugs such as Cytoxan and Neosar (drugs used during chemotherapy), and long-term catheter placement are also considered agents that may increase the incidence of bladder cancer, reports Paul Perito MD.

According to the urologist and surgeon, a radical cystectomy may be performed through a small dissection in the lower abdomen. It is often available as a laparoscopic procedure, adds urologist Paul Perito MD. Once the bladder and surrounding infected tissue have been removed, a surgeon may utilize a portion of the small intestine to create an ileal conduit which will then be mapped though a urostomy into sterile bag to be emptied as needed, reports Paul Perito MD. If the urethra remains intact, a neo-bladder may be created which will allow an urination process similar to the pre-operative condition.

Recovery after a cystectomy may take 6 to 8 weeks for completion, reports Paul Perito MD. Men with bladder cancer may also have to undergo a radical prostatectomy if the cells spread to the prostate. Urine leakage, infection, bowel obstruction, injury to the rectum, as well as infertility are all common complications of a radical cystectomy procedure.

This is not a comprehensive guide to bladder cancer or radical cystectomy, cautions Paul Perito MD. More information can be obtained by an open conversation with your urologist or by scheduling an appointment at Perito Urology by calling 305-444-2920 or on the web at www.peritourology.com

Paul Perito MD is a Coral Gables, Florida-based urologist whose practice, Perito Urology, specializes in men’s health issues. Most notably, Dr. Perito has developed and actualized a minimally invasive penile implant procedure that is safe, efficacious, and proven to diminish the risk of infection to the patient. He is the Chairman of the Urology Department at Coral Gables Hospital as well as an active member of the American Urological Society. Paul Perito MD has traveled abroad extensively to promote his minimally invasive penile implant technique. He is a 1988 graduate of the University Of Maryland Medical School and also holds a BA in chemistry from Emory University.

The information contained in this article is provided by Paul Perito MD for educational purposes only. It is not intended to treat or diagnose any condition.

Part Two: Dr. Paul E. Perito Explains the Rest of the Surgical Procedure to Implant the Titan Prosthesis

Dr. Paul E. Perito

Dr. Paul E. Perito

For Part One of this interview, click here.

InformatioNation Blog: Welcome back, Dr. Paul E. Perito. When we left off, you were just about to explain the cylinder placement process. Can you do that now?

Dr. Paul E. Perito: When placing the cylinders, the stay sutures act as my retractor-less retractor; one simply needs to tell your assistant to pull on the blue or pull on the clear and this eases the placement of the cylinder.

InformatioNation Blog: Do you use RTEs?

Dr. Paul E. Perito: I rarely use rear tip extenders greater than 1 cm so that the axial strength of the erection falls on the cylinder itself. Also, by minimizing the use of RTEs, there is a more physiologic erection with no hinging effect.

InformatioNation Blog: You again utilize the artificial erection here, via rapid inflation. What does that accomplish?

Dr. Paul E. Perito: The rapid inflation allows me to check both the functional and the cosmetic result of the implant. I can make sure that the cylinders are in the mid-glands, that they are in the proper position. It also assists in seeding the implant proximally. If there’s any modeling that needs to be performed, it can be performed at this time.

InformatioNation Blog: What size reservoir do you use?

Dr. Paul E. Perito: I use reservoirs appropriate for the patient. With any of the larger implants, I choose to leave some fluid in their cylinder so the patient does not need to fill the implant with an inordinate amount of effort.

InformatioNation Blog: And the pump, where do you prefer it to reside?.

Dr. Paul E. Perito: The pump is placed in the most dependent portion of the scrotum, with its final position being achieved by gently pulling down on the pump thus releasing the dartos fascia making it easy for a right or left handed patient to operate.

InformatioNation Blog: How do you decrease the incidence of redundant tubing in the infrapubic area?

Dr. Paul E. Perito: The pump is pulled up to mid-scrotum prior to making the connections. This also makes the connections easier for those with big fingers. Once the connection is made, the pump is returned to the most dependent portion of the scrotum, thus disposing of any of the redundant tubing.

InformatioNation Blog: And the drain?

Dr. Paul E. Perito: The drain is placed in a separate stab wound; and we drain the entire wound running from the scrotum all the way up to the infrapubic area. It should be noted that everyone receives a 10-pound sandbag right on the infrapubic area in the recovery room, which is usually left in place for two hours all designed to diminish the amount of post operative swelling.

InformatioNation Blog: Any final words?

Dr. Paul E. Perito: This minimally invasive penile implant procedure is an easily reproducible, safe and efficacious alternative to traditional penile implant placement procedures. I appreciate your allowing me to speak with you today.

InformatioNation Blog: Thank you.

Dr. Paul E. Perito graduated the University Of Maryland School Of Medicine in 1988. His Coral Gables, Florida, urology center, Perito Urology, draws patients from around the globe for its innovative and updated Erectile Dysfunction treatments. Having successfully performed over 3,000 penile implants since 2005, Dr. Paul E. Perito is considered a leader in the field. His signature minimally invasive technique, The Perito Approach, has been taught to surgeons worldwide through travel and at Coral Gables Hospital, where he is Director of Urology. Dr. Paul E Perito has participated in countless medical studies in his quest to simplify the penile implant process and make the procedure safer for his patients.

The information contained in this article is provided by Dr. Paul E. Perito for educational purposes only. It is not intended to treat or diagnose any condition.