- NON-INVASIVE CANCER
Surgery is the main treatment. A cystoscope is normally used to remove one or more small tumors.
- Cystectomy - surgery to remove the bladder
This is only necessary in very few cases and is normally done when other treatments have been tried. The aim is to eliminate the cancer before it spreads into the muscle layer and possibly to other parts of the body.
- INVASIVE CANCER
Surgery for invasive bladder cancer means eliminating all of the bladder. When the bladder is removed, surgeons search for alternative means to allow the patient to pass urine.
Patients may receive chemotherapy before surgery in order to decrease the tumor's size.
Normally, the bladder and nearby structures are removed; this is known as radical cystectomy. It is normally performed in stage 2 or 3 bladder cancers.
- Treatment in men
In men, the bladder, prostate, seminal vesicles (where semen is stored), and lymph nodes are removed.
After having a radical cystectomy, men have a high risk of not being able to get or keep an erection (erectile dysfunction). They will also be incapable of ejaculating, thus making them infertile. All of this will be discussed with you before you have the surgery, and you will learn about the best ways to manage erectile difficulties. Also, arrangements may be made to store your sperm before the operation.
- Treatment in women
Women have their bladder, nearby lymph nodes, and urethra removed. Sometimes, the uterus, ovaries, cervix, and part of the vagina are also removed. If you have not gone through menopause, the uterus and ovaries may be left in place. Before the operation, the effects that this may have on fertility and sex life will be discussed with you.
- Urinary diversion
When the bladder is removed, a new receptacle is constructed to hold urine; this procedure is known as urinary diversion. There are several ways to do this:
- Urostomy (ileal conduit)
This is the most common type of urinary diversion. The urine is collected in an external pouch connected to the abdomen.
A section of the small intestine (ileum) is removed and joined to the two ureters at one end, and at the other this is connected to the abdomen through a small opening in the skin. The ureters carry urine from the kidneys through the piece of intestine that acts as a channel (conduit) toward the abdomen and to the outside. This is why the operation is sometimes called an ileal conduit. The small opening in the surface of the abdomen, called a stoma, is where urine is excreted from the body.
- Urinary diversion
With this type of urinary diversion there is no need for an external pouch to collect urine. A section of the intestine is used to make an internal pouch that can collect urine inside the abdomen. The ureters are connected to the pouch and direct urine from the kidneys into the pouches.
The way in which the pouch is emptied depends on the type of pouch the patient has. There are two types of internal pouch: one is cutaneous urinary diversion and the other is called a neobladder. Both require a different type of surgery.
- Cutaneous urinary diversion: the internal pouch that replaces the bladder is connected to the abdominal wall using a small opening called a stoma. The pouch empties 5 or 6 times a day through the stoma using a tube (catheter).
- Neobladder: This is also known as bladder reconstruction. In this case, the pouch is connected to the urethra so that urine is stored just as it used to be stored by the bladder and is then passed through the urethra and expelled from the body. To do this, it is necessary to flex the abdominal muscles on a regular basis because the patient will have lost the ability to feel that their bladder is full.
Some patients may also need to use a catheter to empty the new bladder.