Professor Guram Karazanashvili, oncourologist, is a Georgian doctor whose surgeries have piqued interest of American oncologists
In oncology, oncourology and surgical oncology, bladder cancer cases are considered to be the most complex surgeries. The difficulty lies in the fact that, during the surgery, the bladder and all the organs and tissues around the prostate are removed and a neobladder is formed. Guram Karazanashvili, Doctor of Medical Sciences, Professor, President of the Association of Oncological Urology and an oncourologist, is a doctor who created a neobladder long time ago and has enabled many patients to continue living a full life after the treatment of bladder cancer.
An interview to AMBEBI.GE
One side of this complex surgery is oncological, that is, when the cancer is removed, and the other side is functional, when the bladder is removed and the urine is routed to exit the body. There are many methods used today: sometimes, the urine is routed to the surface and is then collected in a cellophane or plastic bag, and in other cases – to the large intestine. All these methods are well tested. In our case, urine is collected into an artificial bag, a neobladder. It is one of the most complex surgeries, lasting 7 to 8 hours and with expected complications, not only in our country but worldwide.
What are the possible complications?
When the neobladder is formed, there can be bowel problems, obstruction, peritonitis, urinary incontinence, and impotence. But this surgery is virtually the only way to radically treat bladder cancer and save the patient. That’s why we try to minimize complications and ensure comfortable conditions in the postoperative period.
We offer a new nerve sparing technique that allows people to preserve potency after the bladder removal. This is important because our patients are often young men. It is desirable not to damage their potency to preserve their family life.
We also developed a special sphincter sparing technique and minimized the risks of urinary incontinence. After this surgery, there is no major social problem when the patient needs to wear a diaper.
In fact, the methods you have developed give the patient the opportunity to recover quickly and get their life back on track after the surgery. What is a neobladder made of?
The bladder is the reservoir that is filled with urine. A healthy bladder means healthy kidneys. When there are problems with the bladder, there are problems with the kidneys. The methods used in the past were harmful to the kidneys: in such cases, the kidneys often fail, the patient is put on dialysis, and an artificial kidney is transplanted. Correspondingly, the closer the bladder is to the natural bladder, the more complete it is. The neobladder is created exactly for this purpose. A certain segment (60 cm) is taken from the small intestine, which is 5 meters long, in such a way that it does not affect the small intestine function in any way. Also, it is important to preserve the blood supply in the blood vessels.
How well does this surgery pay off?
It is by far the most effective radical and, at the same time, the most comfortable option. In general, we have been using a similar technique for a dozen of years and, during this time, have also invented and improved new modifications.
You presented this method – a scientific, clinical and practical innovation – at the Congress of the Urological Association in the US.
Yes, this Congress is one of the most large-scale, authoritative, scientific and practical events. Not all people can present a report because it undergoes detailed review and must be of high quality. There must be a high degree of credibility. A specially created scientific committee reviews the reports via blind peer review: the reviewer doesn’t know whose work he is reviewing, and we don’t know who the reviewer is. This is done to eliminate subjectivity: the Association is responsible for the innovation.
We are proud that our innovation was presented in the video format. We performed this surgery in the operating room of our hospital. We didn’t film it on purpose. The video explains the essence of the operation, all the technical nuances, and provides video instructions. The surgery was performed in November 2017. The patient was a 58-year-old man, he feels good and still has potency. There is no cancer.
We shared our experience with American urologists. It will be saved in the video library and will be available to any urologist in the world who wants to watch it and probably put it into practice.
Work on similar methods had been done. What were your results? What does it mean for you personally?
For example, yesterday, I saw a man who underwent surgery 8 years ago: he feels well and lives a normal life. This, of course, is pleasing.
How affordable is this surgery?
It is quite affordable. In America or even in Turkey, similar surgeries cost tens of thousands. We offer quite a reasonable price, and the surgery is covered by universal health insurance.
What is the rehabilitation process?
The rehabilitation is easy. However, the patient cannot be discharged on day two after such a major surgery. If all goes well, the rehabilitation lasts 10 days.