After being diagnosed with an aggressive form of bladder cancer at age 40, Brian Mushlin spent the next five years trying to beat the disease through a multitude of medical treatments. But with each new chemotherapy drug, success was fleeting. While an initial follow-up test would appear promising, the cancer would soon creep its way back into his body.
“I kept thinking, ‘Onto the next treatment,’ but after a certain point, there really were no more treatments,” he said. “My doctor told me, ‘We need to start thinking about removing your bladder.’”
It was an option Mushlin, now 46, had hoped to avoid. For most patients, bladder removal requires a patient to undergo a urostomy — a surgical procedure that creates an opening, or stoma, in the abdominal wall that allows urine to pass through and empty into a pouch worn on the patient’s body. For the rest of their lives, patients must drain the bag several times each day as it accumulates urine.
In addition to being a young, active father of three, Mushlin is also a Cambridge Police patrol officer, SWAT team member, marksman and firearms instructor. Although very eager to have his cancer removed, he was concerned about the challenges a urostomy pouch could pose while, for example, serving a warrant or apprehending a suspect.
“Sometimes my job is a bit physical. What would happen if the bag was damaged or punctured, or how would I drain it at work, in uniform?” Mushlin said. “I’ve been a police officer for 21 years, and I want to continue my career in law enforcement, but it would be difficult if I had to manage a urostomy bag in my line of work.”
Seeking a second opinion, Mushlin and his family met with the Brigham’s Matthew Mossanen, MD, of the Division of Urology, to explore other options. Mossanen told Mushlin he was a good candidate for a novel procedure called neobladder reconstruction, which creates a substitute bladder from a portion of the patient’s intestines after bladder-removal surgery. During the procedure, surgeons connect the neobladder to the patient’s ureters — two tubes linking the bladder and kidneys — and urethra.
The substitute organ is placed in the original bladder’s location. Eventually, patients can urinate normally and maintain continence.
While a neobladder functions similarly to a regular bladder, it does lead to differences in sensation. Intestinal tissue doesn’t have the same nerves that tell the brain when you need to urinate; instead, patients with a neobladder must learn to recognize different bodily cues, sometimes described as feeling similar to abdominal fullness.
“Brian is unusually young for this type of bladder cancer, which on average is diagnosed at age 74,” said Mossanen, who performed the surgery with a large multidisciplinary team that included Steven Chang, MD, MS, of Dana-Farber/Brigham and Women’s Cancer Center. “Older patients typically are not as active, and therefore many are comfortable with a stoma. It’s a very personal decision. For Brian, a neobladder offered a much better quality of life compared to a stoma.”
Unparalleled Care and Compassion
Mushlin — who underwent the nine-hour, robot-assisted surgery in July — said he feels stronger and more confident each day. Within six weeks of discharge, he was back to walking his dog around his Walpole neighborhood, doing errands and beginning to try light exercise at the gym. His cancer is now in remission, and his care team continues to closely monitor his health and progress.
The Brigham is one of the few hospitals in New England to perform robot-assisted neobladder reconstruction, an approach that enables surgeons to perform the complex procedure less invasively and with greater precision.
“We have a highly skilled multidisciplinary team with an amazing breadth of talent and experience,” Mossanen said. “While smaller hospitals will maybe do one of these procedures a year, we perform several each week. And a big reason why they go so smoothly is because there’s a large, specialized group of people — from the clinic to pre-op to the OR to the floors — ensuring that our patients receive the very best care.”
Mushlin agreed, noting that he was continually impressed by not only the quality of care he received, but also the warmth and compassion he and his family experienced every step of the way.
“From the minute I met with Dr. Mossanen, I knew I was in good hands, and he came to see me every day when I was in the hospital. The nurses and patient care assistants on the floor were also unbelievably awesome. Even after I went home, the staff continued to make themselves available and invited me to call the floor directly if I had any questions,” Mushlin said. “All of that means a lot to me. I mean, that’s what you’re looking for as a patient — they really care.”