[curiousG]

Surgery before or after a stem cell transplant?

by curiousG on Thu Feb 26, 2015 11:18 am

My mom was diagnosed with a severe bladder prolapse. She needs surgery to correct the prolapse, but there seems to be some debate on whether she should do it prior to a stem cell transplant or after.

These are our options/concerns:

1. She could get fitted for a pessary (ring inserted through the vagina to hold bladder in place) and proceed with the transplant. I am apprehensive this would introduce additional infection risk and would also delay corrective surgery for a considerable amount of time after the transplant?
    
2. She could undergo corrective surgery prior to the transplant. I am apprehensive of how this would affect her treatment (I assume she stops chemo prior to surgery) and how long her transplant would be delayed.

I realize no one can advise us on what to do, but I would love to hear others' opinions on mom's situation. Maybe there are alternatives we haven't been presented with? I figure it couldn't hurt to ask!

Thanks and take care everyone -
Crystal

[lys2012]

Re: Surgery before or after a stem cell transplant?

by lys2012 on Fri Feb 27, 2015 2:32 pm

Hi there,

I'm not a doctor, so this is just based on my experience. The stem cell transplant took me a lot longer to recover from than I though it would, and I was in my early thirties with no other health issues! At least two months were a write off, where I barely made it out of my apartment except to go to appointments or for rides in the car with my husband as he did errands (I would wait in the car as I was too fatigued to go shopping etc).

If she has an urgent need for surgery, I think it would be better to do it before transplant, when her blood counts, immune system, etc are all still functioning. These take a while to come back after transplant. If it is more of an elective thing, then wait until after transplant or until blood counts etc improve.

Her doctors should advise her on this though? What is their opinion?

[Ladyaero]

Re: Surgery before or after a stem cell transplant?

by Ladyaero on Fri Feb 27, 2015 5:37 pm

My husband delayed a much needed hemorrhoid surgery and proceeded with his transplant.That was a big mistake. The transplant exacerbated gastrointestinal issues (still causes trouble 3 years later), which made the hemorrhoid situation much worse and extremely painful (not to mention the challenges caused when he was bedridden due to complications).

If you think that your mom's bladder issues might cause her discomfort or other challenges (i.e., she will likely be hooked up to IVs at various times and won't be able to get to a bathroom quickly, if at all – could that lead to a situation she would not be able to / want to deal with?), then I would suggest she have the surgery before the transplant.

Only her doctor can tell you what the risk of delay is, though.

[Dr. Jonathan Kaufman]

Re: Surgery before or after a stem cell transplant?

by Dr. Jonathan Kaufman on Fri Feb 27, 2015 11:06 pm

curiousG

This is a tough situation for your Mom and you. The questions that I would want answers to before making the decision have to do with the recovery time after the surgery and the risk of her myeloma.

From the surgery standpoint: How much recovery time? Could she be on some sort of maintenance therapy during this time? How much time does the surgeon want for recovery before the transplant?

From the myeloma perspective: Does your mom have high-risk disease where a significant time away from treatment could lead to relapse? What is her level of remission? Have stem cells already been collected?

I have counseled my own patients about this in the past. In general, I suggest delaying elective surgery for at least six months after transplant. Emergent/urgent surgeries need to occur right away. It sounds like your mom fits in the middle of those two. Only she and her urologist can really say how elective or not the procedure is. For patients with high-risk disease, I prefer to avoid delays in therapy if at all possible.

I hope this helps. Good luck on your decision.

My best,

Jlk

[cindylouise]

Re: Surgery before or after a stem cell transplant?

by cindylouise on Sat Feb 28, 2015 5:49 pm

Not knowing all the details of your mom's bladder situation, I would think it would be better to do it before transplant. Working with skilled care patients, we see people with prolapsed rectums, bladders and others. My thought would be that the GI issues associated with transplant would further worsen her prolapse. I'm thinking about this from a gravity type perspective, (a lot of time on the toilet). Are they considering a bladder sling? My understanding is that is not terribly invasive. Limits on lifting tho. Not expert advice for sure, but just some thoughts.