Treatment and surgery for bladder cancer (bladder tumours)
Transurethral resection of the bladder (TUR-B) and complete removal of the bladder with urinary diversion for advanced bladder tumours (bladder cancer) as an important surgical treatment method for bladder cancer
The first step in the treatment of tumours of the urinary bladder (bladder cancer) is the removal of the suspicious tissue via the urethra. An electric loop is used to remove the tissue chip by chip, and it is sent for histological examination (TUR-B). Depending on the histological result, a decision must then be made on the further treatment method for the bladder cancer (watchful waiting, instillation of medication into the bladder, repeat TUR-B, surgical removal of the urinary bladder). The detection of bladder cancer can be facilitated by so-called fluorescence cystoscopy. In this case, a special fluorescent dye is introduced into the bladder in the clinic before the operation.
In the case of advanced bladder tumours, complete removal of the urinary bladder may be necessary in order to cure the patient of bladder cancer (bladder carcinoma). For urinary diversion, a replacement bladder is then reconstructed from the patient's own bowel or a connection to a urine bag system is created.
Bladder carcinoma is the fifth most common tumour in men and the tenth most common tumour in women. The probability of a man developing bladder cancer is about three times as high as for a woman.
TUR-B at a glance
| Indication | Removal of bladder tumours / bladder cancer |
| Principle | minimally invasive operation via the urethra, removal of bladder tissue with an electric loop, if necessary using fluorescence cystoscopy |
| Operating time | approx. 30 min |
| Hospital stay | 2–3 days |
| Note | Spinal anaesthesia or general anaesthesia |
Questions about TUR-B
Transurethral resection of the bladder (TUR-B) is the treatment of choice for all newly diagnosed tumours of the urinary bladder. The most common forms of malignant bladder tumours can usually be treated completely with TUR-B. TUR-B can be repeated practically as often as necessary if bladder tumours recur.
TUR-B is a minimally invasive surgical procedure performed via the urethra. The bladder tissue is removed with an electric loop. The tissue is examined histologically in order to determine the exact tumour stage in the case of malignant tumours of the urinary bladder. In this context, it is very important that deeper wall layers are also included in the TUR-B. Depending on the findings, the bladder can be rinsed with a chemotherapeutic agent at the end of the TUR-B, which reduces the risk of recurrent tumours. At the end of the operation, a bladder catheter is inserted, which can usually be removed on the 2nd day after the operation.
No. A very small proportion of malignant bladder tumours have grown into the muscle layer of the urinary bladder. These tumours can often only be treated by removing the urinary bladder or, in individual cases, with radiotherapy. But for the vast majority of bladder tumours, TUR-B, if necessary in combination with chemotherapy instillation into the bladder, is the treatment of choice.
By instilling a fluorescent dye into the urinary bladder before the TUR-B is performed, the endoscopic assessment of the urinary bladder during the TUR-B can be carried out in normal white light and additionally in so-called blue light. In blue-light cystoscopy, certain tumours can be recognised and removed more easily due to their bright red colour. Fluorescence cystoscopy is a new treatment method. In individual cases, it makes it possible to remove otherwise undetected tumours more completely and to prevent tumours from recurring.
In contrast to most other malignant tumours, malignant tumours of the urinary bladder have the characteristic of frequently recurring. New bladder tumours can develop anywhere in the bladder. Depending on the histological type of the respective bladder tumour, the probability is up to 50%. For this reason, it is advisable after a TUR-B to carry out a tumour follow-up examination with cystoscopy, initially every three months and later every six months. If new tumours are then detected, they can usually be treated well by a further TUR-B. To reduce the risk of bladder tumours recurring, the bladder can be rinsed with medication.
Removal of the urinary bladder (cystectomy) at a glance
| Indication | tumour that has grown into the muscle of the urinary bladder (muscle-invasive urothelial carcinoma of the bladder) |
| Principle | Removal of the urinary bladder (in men also the prostate) and the associated lymph nodes, creation of a continent replacement bladder using small intestine, alternatively incontinent urinary diversion via a urine bag (ileal conduit) or creation of a continent pouch |
| Operating time | 4–5 hours |
| Hospital stay | 10–14 days (depending on the type of urinary diversion) |
| Note | Follow-up rehabilitation for 3 weeks recommended |
Questions about the diagnosis and treatment of cystectomy (bladder removal)
In medical terminology, cystectomy refers to the complete surgical removal of the urinary bladder.
The main indication for a cystectomy is malignant bladder cancer that has grown beyond the mucous membrane of the bladder into the muscle wall of the urinary bladder. It may also be necessary to remove the urinary bladder when a gynaecological tumour or bowel cancer is diagnosed in order to cure the patient of the tumour. However, benign changes such as a contracted bladder or fistulas between the pelvic organs can also make bladder removal necessary.
After removal of the urinary bladder, the urine produced by the kidneys must be diverted. This is usually done using parts of the patient's own bowel, from which the urinary diversion is reconstructed. A distinction is made between incontinent urinary diversions such as the ileal conduit and continent diversions such as the ileal neobladder or the MAINZ pouch. With incontinent urinary diversion, a bag is required after the procedure to collect the urine; with continent urinary diversion, this is not necessary, although depending on the surgical procedure, the reservoir must be emptied with a catheter.
The inpatient stay after bladder removal lasts approx. 2 weeks. Depending on the type of urinary diversion, a short stay at home is followed by a short check-up phase of a few days in the clinic before follow-up rehabilitation – usually lasting 3 weeks – begins. Overall, a treatment and recovery period of 3 months must be expected.
Symptoms of bladder cancer
What are the symptoms of bladder cancer?
Bladder cancer is not easy for those affected to detect. The main and early symptom is blood in the urine. In some cases, the bladder also becomes irritated, which is wrongly interpreted as a bladder infection. Therefore, a supposed bladder infection that does not heal within a few days should always be checked by a doctor.
Bladder cancer occurs predominantly in the 50 to 80 age group. Men are affected three times as often as women. Smoking promotes the formation of bladder tumours. If bladder cancer is detected early, the prognosis for a cure is good.
These symptoms may indicate bladder cancer
- Blood in the urine without accompanying pain
- Cystitis that does not heal within a few days
- Urge to urinate
If these symptoms occur, you should consult a urologist or a specialist urological clinic so that bladder cancer can be ruled out. If bladder cancer is diagnosed, treatment must be initiated immediately, with the aim of removing the tumour tissue as completely as possible.
Good to know
The most important risk factor for developing bladder cancer is smoking, both active and passive. Avoiding nicotine is therefore the best preventive measure against bladder cancer.
Videos on bladder cancer:
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Superficial bladder cancer
Diagnosis and treatment
Superficial bladder carcinoma is a malignant tumour of the bladder mucosa that can usually be removed endoscopically via the urethra. It does not grow into the muscle layer, but can recur elsewhere in the bladder or upper urinary tract. You can find more information on this in this video.
- Symptoms: Blood in the urine, visible or microscopic.
- Diagnosis: Cystoscopy, if necessary X-ray or MRI; photodynamic diagnostics for better tumour visibility.
- Treatment: Transurethral resection (TUR-B), if necessary laser; tumour base biopsy to distinguish it from muscle-invasive tumour.
- Recurrence prophylaxis: Instillation of mitomycin C or BCG into the bladder, regular cystoscopies (initially every 3 months).
Superficial bladder carcinoma is readily treatable, but requires continuous follow-up in order to detect new tumours early.
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Bladder cancer – superficial or muscle-invasive?
Here you will find all the important information about superficial and muscle-invasive bladder carcinomas.
- Definition: Superficial bladder tumours only grow in the mucous membrane of the bladder. Muscle-invasive tumours extend deeper into the muscle of the bladder wall and can reach lymph and blood vessels.
- Symptoms / significance: Muscle-invasive tumours carry a higher risk of lymph node or organ metastases. Superficial tumours do not carry this risk.
- Treatment
- Superficial: Removal via the urethra using an electric loop (transurethral resection).
- Muscle-invasive: Usually complete removal of the bladder with urinary diversion, e.g. neobladder or incontinent diversion.
- Goal: To completely remove superficial tumours, treat muscle-invasive tumours and prevent metastases.
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Blood in the urine
Why see a urologist immediately?
Blood in the urine is a warning sign and should always be investigated by a urologist. Prof. Lahme explains the most common causes of blood in the urine, including cystitis, kidney stones, bladder cancer, tumours of the urinary tract and changes in the renal pelvis or ureter.
- Blood in the urine: why have it investigated immediately?
- Where can blood in the urine come from?
- How is urine produced in the kidneys?
- Pain vs. painless bleeding
- Common causes: inflammation, stones, tumours
- Examination by the urologist
- Cystoscopy explained
- CT, MRI and further diagnostics
- When no cause is found
Videos on muscle-invasive bladder carcinoma:
In these videos, Prof. Dr. med. Sven Lahme explains what you need to know about the different treatment options for bladder cancer that has already grown into the bladder wall.
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STOMA
This video explains the treatment of muscle-invasive bladder carcinoma in more detail. The urinary bladder has to be removed completely and the urine then has to be diverted in another way.
- Muscle-invasive bladder carcinoma = tumour of the bladder wall, high risk of metastases
- Treatment: complete removal of the urinary bladder (cystectomy)
- Replacement options for the bladder:
- Neobladder: replacement bladder made from small intestine, connected to the urethra
- Incontinent stoma (ileal conduit): urine via a piece of bowel into a bag on the abdominal wall
- Continent pouch: catheterisable reservoir under the abdominal wall (special form)
- Incontinent urinary diversion (ileal conduit):
- Ureters sutured into a short piece of small intestine (approx. 10–12 cm) → connection to the abdominal wall
- The piece of small intestine prevents scarred narrowings of the ureters
- Advantages:
- Shorter operating time
- Easier handling, especially for older patients or those in need of care
- Lower surgical risk compared with the neobladder
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NEOBLADDER
In this video, you will learn everything about the neobladder – a replacement bladder made from small intestine which, after removal of the patient's own urinary bladder, enables continence via the sphincter and pelvic floor.
- Neobladder = replacement of the urinary bladder, connected to the sphincter and urethra
- Description:
- Made from approx. 45 cm of small intestine; the ends of the intestine are sewn back together
- The piece of small intestine is cut open lengthwise and formed into a cavity
- Two small inlet limbs for connecting the ureters → prevent reflux
- Urine flows passively into the neobladder, no active contraction → a weak urine stream is possible
- Emptying: pressure on the lower abdomen is often necessary, sometimes catheterisation is required
- Properties of the intestine remain: slight reabsorption of urine components → risk of metabolic changes (e.g. increased acidity)
- Regular urological check-ups required
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POUCH
In this video, you will learn more about the pouch, a continent reservoir as a replacement for the urinary bladder.
- Pouch = continent reservoir for urine, not connected to the urethra
- Description:
- Urine is collected via a connecting channel to the abdominal wall (e.g. navel)
- Regular emptying with a catheter is necessary
- Suitable if the normal sphincter does not function or is missing
- An artificial continence mechanism is created surgically
- Challenge: a reliable, reproducible continence mechanism is difficult to achieve
- Preferred: neobladder (continent, connected to the urethra) or ileal conduit (incontinent)
Diagnostics
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Cystoscopy
How it works
In this video, you will learn everything important about cystoscopy – an endoscopic examination of the urinary bladder in men and women.
- Purpose: Clarification of subtle changes in the bladder wall, e.g. in the case of blood in the urine, suspected tumours, bladder stones or emptying disorders.
- Procedure: Examination under sterile conditions with lubricating gel and local anaesthesia.
- In women: Use of a rigid endoscope – the short, straight urethra allows a simple examination.
- In men: Use of a flexible endoscope that adapts to the natural curves of the urethra – making it low-pain and gentle.
- Technology: Modern video optics ("chip-on-the-tip") provide clear images; if necessary, minor procedures or tissue sampling can be carried out directly.
- Advantages: Reliable diagnostics, precise assessment of the bladder wall, practically painless today.
About this page:
Author
Medical director of the Goldstadt-Privatklinik.
Specialist for Urology, Mini-PCNL and robot-assisted da Vinci procedures.
Member in Scientific Societies and Reviewer of scientific journals.
