Surgery is the primary treatment for localized bladder cancer (bladder cancer that has not spread). The type of surgery recommended depends on where your bladder cancer is located (which cells are affected) as well as the size of the cancer and how far it has spread.
Transurethral Resection of Bladder Tumor (TURBT)
TURBT is a minimally invasive surgery that’s an option for early-stage bladder cancer. It’s the most common treatment for superficial bladder cancer, also called non-muscle-invasive bladder cancer (meaning the cancer hasn’t grown into the muscle layer). Most people with bladder cancer have this type when they’re first diagnosed, so this is usually the first treatment.
TURBT is performed while you’re under general anesthesia (fully asleep) or regional anesthesia (only the lower part of your body is numbed). Your surgeon will insert a thin tube with a camera (called a resectoscope) through your urethra to visualize the inside of your bladder. The device has a wire loop at the end to remove any abnormal tissues or tumors.
If necessary, your surgeon may recommend a follow-up TURBT to use an electrical current to destroy the area where the tumor was removed (called fulguration). A high-energy laser can also be used. Both methods are done through the resectoscope.
Cystectomy
This surgery is the removal of part or all of the bladder. It’s recommended for people with aggressive cancer (one that grows or spreads quickly) or cancer affecting the muscle layer of the bladder wall.
You may be eligible for a partial cystectomy (in which only part of your bladder is removed) if the cancer is relatively small, localized to one area, and easily accessible.
During a partial cystectomy your surgeon will remove the parts of the bladder wall and muscle layer where the cancer has invaded along with nearby lymph nodes. With this procedure you will keep your bladder, though it will be smaller and cause you to urinate more frequently. This procedure isn’t used very often because there’s a chance that the cancer will occur in other parts of the bladder.
If your tumor is larger or in more than one area of the bladder, you will probably need a radical cystectomy to remove all of your bladder, potentially along with nearby organs, such as the prostate and seminal vesicles in men and the uterus, ovaries, and part of the vagina in women.
For the radical cystectomy, your surgeon may perform an open surgery that requires a long incision in the belly. Alternatively, your surgeon may opt for laparoscopic surgery, also called minimally invasive or “keyhole” surgery. This is performed through several smaller incisions using an instrument called a laparoscope, sometimes with the assistance of robotic arms.
Because your entire bladder is removed during a radical cystectomy, you will need reconstructive surgery to give your body another way to store urine and pass it out of your body. There are three main types of reconstructive surgery:
- Standard or Conventional Urostomy This procedure involves creating a new passageway, called an ileal conduit, for your urine to pass from the kidneys to the outside of your body. Your surgeon uses a piece of the small intestine to create the conduit for urine to pass from the kidneys to an external bag worn on the abdomen, which you empty when it gets full.
- Continent Urostomy A pouch is created from the intestine to hold urine inside the body, which you then drain out by inserting a catheter through a small abdominal opening.
- Neobladder With this procedure, urine is routed back into the urethra through a new bladder constructed from a section of the intestine. Though you pass urine as you did before, you no longer have the same nerve signals telling you when to urinate, so you will have to urinate on a schedule.
