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

The first in treatment of bladder tumours (bladder cancer) is the removal of the conspicuous tissue on its way to the urethra. The tissue is removed with a surgical snare and sent for histological examination. Further treatment is based on the findings of the examination, such as waiting, rinsing the bladder with medication, repeating the histological examination, and removing the bladder. Detection of bladder tumours can be facilitated by fluorescence cystoscopy. In this technique, a special fluorescent dye is introduced to the bladder prior to the surgical procedure.

In the case of advanced bladder tumours, complete removal of the bladder may be necessary. Urinary diversion is then done either through a replacement bladder reconstructed from the patient’s own bowel or a connection to a urine drainage bag.

Short info on TURB

Indication Removal of bladder tumours
Procedure Minimally invasive surgery via the urethra, removal of bladder tissue with a surgical snare, use of fluorescence cystoscopy if necessary
Surgery time Approx. 30 minutes
Clinic stay 2-3 days
Note Spinal anaesthesia or general anaesthesia

Questions about TURB

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.

Short info on removal of the bladder (cystectomy)

Indication An ingrown tumour in the muscles of the bladder (muscle-invasive urothelial carcinoma of the bladder)
Procedure Removal of the bladder (as well as the prostate in men) and the accompanying lymph nodes, creation of a continent replacement bladder using the small intestine, alternatively incontinent urinary diversion via a urine bag (ileum conduit) or creation of a continent pouch
Surgery time 4-5 hours
Clinic stay 10-14 days (depending on the type of urinary diversion)
Note Follow-up treatment for three weeks recommended

Questions about the diagnosis and treatment of a cystectomy (bladder removal)

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.