Bladder cancer treatment journey with minimally invasive laser surgery
“I thought it wasn't serious until I saw drops of blood in the toilet.”
Mr. John Robert Sutton is a businessman who travels the world to scour culinary ingredients and sample indigenous cuisine. He was hail and healthy until mid-2023 while in Paris celebrating Bastille Day, he noticed something was wrong with his urine.
“Maybe my urine had a funny color because I drank too much champagne. I thought it was not serious and would be clear if I drank more water. A few weeks passed, but the problem persisted. When I saw a drop of fresh blood in the toilet, I started to worry. I contacted my friend in Thailand to take me to a hospital for a health checkup.
Since John once had dental surgery in Thailand with satisfactory results, he trusts the quality of medical treatments and services in Thai hospitals. He left for Thailand on Saturday, arrived Sunday night, and underwent an examination on Monday. This time, his friend took him to MedPark Hospital.
“Upon setting my feet at MedPark Hospital, I couldn't believe my eyes. What is this place, a five-star hotel? It is clean and spacious. I thought I would have to wait for some time and answer hundreds of questions, but no, I only needed to sign a paper to start a checkup process. Plus, it took only 3 hours; if I were in the US, the lobby would be packed with people, and it would take nearly three months to complete all checkup test items.”
The checkup indicated early-stage cancer
After blood tests, X-ray, and ultrasound, he was referred to the Urology Clinic and saw Dr. Paibul Boonyapanichskul, a urological surgeon. He looked at the X-ray result and scheduled John for a cystoscopic biopsy appointment the next day.
“Dr. Paibul was a genius, meticulous, kind, considerate, and straightforward. On the day the biopsy report came out, I was shocked. He ordered a CAT scan and scheduled surgery for Monday morning. I was like, what, Monday morning? From not knowing I have cancer to the diagnosis and treatment in less than a week, this was incredibly quick.”
Dr. Paibul diagnosed the bladder stone identified on X-ray imaging as due to early-stage cancer. He promptly scheduled surgery to remove the cancerous stone. The surgery was a resounding success.
“Dr. Paibul utilized laser surgery. It is a process that demands meticulousness. He is skillful and well-trained. My incision is miniscule. It is incredible, especially the expeditious diagnostic process and advanced treatment that can rid the disease in time before it spreads. I did not experience any postoperative pain nor need to use pain relievers at all.”
In addition to the swift diagnosis and treatment, John was impressed by the clinical care of the doctors and nurses.
“The first six days were remarkable. I can say I was one of Dr. Paibul's best patients. He was delighted with the treatment outcome. He laughed and smiled; his reaction said it all. The nurses at the hospital are smiley and happy to serve patients. They also perform venipuncture nimbly and adroitly. After surgery, I stayed in an inpatient room accoutered with a private bathroom and a spectacular view. It was like being in a suite room of a five-star hotel. These factors inspired me to come back for curative treatments.”
What impressed him more was the tasty Thai, American, and Japanese hospital cuisines.
“I am in the food industry and usually go to Michelin-starred restaurants. I have plenty of the best dishes in the world. During my stay here, I had shrimp pasta, it was perfectly delicious. This dish is typically on the menu of five-star restaurants in New York and LA. When my chef friends saw the picture of this dish, they couldn't believe I was at a hospital. This place has no hospital smell at all. If you look around, you wouldn't even know you are at a hospital. You must see it to believe it.”
“I want to tell everyone that if you see blood in your urine, please see a doctor immediately. Although it may be conditions other than bladder cancer, prompt diagnosis is essential regardless of the hospital. However, it was MedPark Hospital that saved my life.”
Bladder cancer: A cancer men should be aware of
When it comes to urological cancers, statistics indicate bladder cancer is one of the most prevalent. It is common among males between 50-70 years old; 95% is transitional cell carcinoma. This type of bladder cancer begins in the urothelial cells with uncontrolled cell divisions that lead to a tumor. If left untreated, the tumors continue to grow and can metastasize to nearby organs.
Despite unclear causes, risk factors that play a role in developing bladder cancer include being overweight, smoking, and exposure to certain chemicals.
Dr. Paibul Boonyapanichskul, a urological surgeon.
Observing for the signs and symptoms of bladder cancer
Painless hematuria or bloody urine is a sign noticeable to the patients themselves. Some may experience associated symptoms such as frequent urination, lower abdominal pain, and pain in the distal urethra while urinating. In patients with aggravated symptoms, the urine may be frankly bloody. If noted and seeking treatment without delay, assuring successful treatment. Bladder cancer is not as dreadful as it may seem.
In John's case, he went to the hospital for consultation of his bloody urine. Dr. Paibul Boonyapanichskul, a urological surgeon, initiated the diagnostic investigation with ultrasound.
“The KUB ultrasound demonstrated a stone-like 2-3 centimeters lump at the apex or dome of the bladder. It had been there for a while as there were calcium deposits on it, and there was a high chance it would be cancer. Nevertheless, a biopsy for pathologic confirmation is necessary.”
Dr. Paibul utilized a cystoscope, a long endoscope equipped with a camera and light source at the tip, inserting it through the urethra into the bladder to remove a tissue sample for pathologic diagnosis. The biopsy confirmed it was cancer. Cancer at the dome of the bladder is treated traditionally with open surgery. However, John is MedPark's first cancer patient treated with this laser surgery.
“Usually, we perform cystoscopy with rigid scope to remove bladder cancer with an electrosurgery wire loop, but this case was difficult because the cancerous tumor was far from the bladder neck. The rigid cystoscope cannot reach the site of cancer. Luckily, our hospital employed a PVP Greenlight Laser for benign prostatic hypertrophy, which we utilize for this case. The laser easily reached the cancerous tumor. If we did not have this laser technology, we would have to perform open surgery to remove part of the dome of the bladder, cutting around the cancerous tumor.”
Dr. Paibul Boonyapanichskul, a urological surgeon.
PVP Greenlight Laser: Less pain and no bleeding
Laser surgery differs from typical cystoscopic electrosurgery, the operating surgeons should have had hands-on experience with this technology to a certain degree, Dr. Paibul explained.
“Recovery time for traditional cystoscopic surgery is three days, and seven days for open surgery. As for electrosurgery, the recovery time is at least three days. In John's situation, electrosurgery was not possible because it could not reach the apex of the bladder; we had to switch to the laser. The surgery lasted less than an hour, resulting in minimal injury, and patients may be able to go home right after the surgery.”
“But since general anesthesia or spinal anesthesia is required for laser surgery, at least one night of a hospital stay for assurance is wise. Patients can go to work the next day without extended medical leave. The outcome is usually satisfactory as the process is more convenient for patients; no bleeding, clear urine, fast recovery time, and immediate resumption of normal life after discharging from the hospital.”
Dr. Paibul Boonyapanichskul, a urological surgeon.
Preventing bladder cancer recurrence with immunotherapy
Dr. Paibul explained that endoscopic surgery is enough for mild bladder cancer. As for John's case, adjuvant immunotherapy is necessary. The treatment involves injecting the Bacillus Calmette–Guérin vaccine into the bladder to stimulate the immune system to fight off cancer cells.
“His tumor is a high-grade cancer. So, there is a high chance of recurrence. He is cured for now, but there is a chance of cancer developing in other areas of the bladder. This means periodic follow-up cystoscopies are crucial to evaluate the bladder and inject the BCG immunotherapy.”
“BCG vaccine is very effective in decreasing the risk of cancer recurrence. We administer the vaccine to the bladder directly through a catheter. At first, we will administer BCG once a week for six weeks. Then, booster doses will be administered every three months for two years.”
Dr. Paibul emphasizes that everyone should regularly observe their urine as it is the easiest way for early detection of bladder cancer. If you are not sure about your risk of developing bladder cancer, a urinalysis at a hospital is beneficial. If abnormalities are detected, doctors can provide early treatment through cystoscopic or laser surgery.
“Every cancer case treatable with traditional cystoscopic surgery is also treatable with PVP Greenlight Laser. This technique has been in use for almost 20 years, and I have employed it with my benign prostatic hyperplasia patients. The results were as effective as cystoscopic surgery. Its advantage is less postoperative pain. Despite a higher cost, the benefits to the patients far outweigh the cost of surgery.”
