Learn The BasicsThe primary treatment option for bladder cancer is surgery. The location of the cancer determines which type of surgery is done.
The types of surgery used to treat bladder cancer include transurethral resection (TUR) with fulguration, partial cystectomy and radical cystectomy with urinary diversion.
Transurethral resection (TUR) with fulguration
In this type of surgery, the tumors are removed through the urethra—the tube carrying urine from the bladder to the outside of the body—using a device called a resectoscope, without removing the bladder.
The resectoscope has a small wire loop that carries electrical currents. The surgeon uses this loop to remove the tumor. The surgeon will then use fulguration to destroy any remaining cancer cells and stop the bleeding.
This type of surgery is used to both treat and diagnose bladder cancer.
Partial cystectomy
A cystectomy refers to the removal of the bladder. A partial cystectomy involves the removal of a cancerous tumor in one part of the bladder. The surgeon also often removes the nearby lymph nodes to assess whether the cancer has spread.
After removing the tumor, the surgeon repairs the remaining part of the bladder so it can continue to function normally.
A partial cystectomy is not commonly used to treat bladder cancer. However, it may be used to treat a very rare type of cancer called adenocarcinoma of the bladder.
Radical cystectomy with urinary diversion
A radical cystectomy involves removing the entire bladder and the nearby lymph nodes.
In this type of surgery, part of the bowel is also often removed.
In men, the prostate, seminal vesicles (the glands storing semen) and part of the urethra, and in women, the uterus, ovaries and part of the vagina may also be removed.
During a radical cystectomy, the surgeon also creates a urinary diversion to allow the urine to be removed from the body.
This could be done using parts of the intestines to allow urine to pass from the kidneys to an ileal conduit, a urinary reservoir pouch called an Indiana Pouch or a neobladder.
An ileal conduit involves utilizing a small part of the intestine called the ileum to create a new pathway for urine to leave the body into an external bag called an ostomy bag. The ileal conduit itself does not store urine.
The Indiana Pouch is a urinary reservoir that allows the urine to be discarded without the need for a bag. In this case, the right colon is removed from the rest of the bowel and re-shaped into a pouch that can hold urine, which is then drained with a catheter that is inserted into the skin.
A third option is to construct a neobladder, or new bladder, using a piece of intestine, which is placed in the same location as the normal bladder. This option allows the patient to have more control over their urination.
A radical cystectomy is generally used to treat bladder cancer that has grown into the muscle tissue beneath, or that has come back following treatment.