Transurethral resection of the bladder (TURB) and complete removal of the bladder with urinary diversion for advanced bladder tumours

Transurethral resection of the bladder (TURB) is the treatment of choice for bladder tumours when the patient has not had these before. The most common types of malignant bladder tumours can usually be completely treated with TURB. TURB can be repeated as often as desired if the bladder tumours recur.

TURB is a minimally invasive surgical procedure performed through the urethra. The urinary bladder tissue is removed using a surgical snare. In cases where the bladder tumour is malignant, the tissue is examined to determine its exact stage. In order for the results to be as precise as possible, it is important that tissue from the deep layers of the walls of the bladder are also gathered during the TURB. Depending on the findings, the bladder may be rinsed with a chemotherapeutic agent after the procedure, which reduces the risk of the tumour recurring. As the end of the surgical procedure, a urinal catheter is inserted, which can normally be removed on the second day after the operation.

No. A very small proportion of malignant bladder tumours grow into the muscle layer of the bladder. These tumours can often only be treated by removing the bladder or, in certain cases, with radiation. However, for the vast majority of bladder tumours, TURB, if necessary combined with irrigation of the bladder with chemotherapy, is the treatment of choice.

By introducing fluorescent dye into the bladder before performing a TURB, endoscopic assessment of the bladder can be performed during the procedure under both normal white light and under blue light. In the blue light cystoscopy, certain tumours can be easily recognised as they appear bright red, allowing the surgeon to remove them. Fluorescence cystoscopy is a useful procedure that can be used to completely remove tumours that may be otherwise undetected and to prevent recurrence.

Unlike most other malignant tumours, malignant bladder tumours have a frequent rate of recurrence. New bladder tumours can develop in any part of the bladder. Depending on the type of tumour, the probability of recurrence is up to 50%. For this reason, it is recommended that follow-up examinations that include a cystoscopy be carried out at quarterly and later half-yearly intervals following a TURB. If new tumours are detected, these can usually be treated by another TURB. To reduce the risk of recurrence of bladder tumours, the bladder can be flushed with medication.

A cystectomy refers to the complete surgical removal of the bladder.

The main reason for a cystectomy is malignant bladder cancer which has grown over the mucous membrane into the bladder’s muscle wall. Similarly, if a gynaecological tumour or bowel cancer is diagnosed, it may be necessary to remove the bladder. Benign changes such as a shrunken bladder or fistula formation between the pelvic organs can also make bladder removal necessary.

The urine produced by the kidneys must be drained after the bladder is removed. This is normally done by using the body’s own intestinal sections to construct the urinary diversion. A distinction is made between incontinent urinary diversions such as the ileum conduit and continent diversions such as the ileum neobladder or the MAINZ pouch. In the case of incontinent urinary diversion, a bag supply is necessary after the procedure to collect urine. In the case of continent urinary diversion, this can be dispensed with, although depending on the surgical procedure, a catheter may be necessary.

The inpatient stay after bladder removal lasts about 2 weeks. Depending on the type of urinary diversion, a short stay at home is followed by a short control phase of a few days in the clinic before the follow up treatment begins, which usually lasts 3 weeks. In total, the treatment and recovery periods are at least 3 months.