Treatment of muscle invasive bladder cancer

Malignant tumours growing into or through the bladder wall (T2,T3)

If a tumour being removed through the urethra is found to be growing into the bladder wall, it is not possible to perform full cleaning of the tumour when removed through the urethra.
The only prospect of successful healing is by performing a complete surgical removal of the urinary bladder (radical cystectomy). Although the alternative exists of combining radiation treatment with chemotherapy, it often does not lead to the same level of success as surgery.

Which organs need to be removed in the case of full bladder removal?

With men, these are the bladder, prostate and seminal vesicles, possibly preserving the erectile nerves and maybe also involving removal of the urethra and pelvic lymph nodes
In the case of women, it is the bladder, uterus, ovaries, anterior vaginal wall, and pelvic lymph nodes

What are the most common surgical techniques?

• Non-continent urinary diversion, for example: ileal conduit

  This operation involves taking an approximately 15 cm long piece of the small intestine from the lowest point of the abdomen and grafting the ureters to one end of it. The other end is diverted through the abdominal wall. This creates an artificial bladder outlet that leads into an adhesive urine bag.
  From a technical point of view, this is a simple operation that creates few long-term problems.

• Continent urinary diversion, for example: ileal neobladder Pouch

  For this operation, a 50-70 cm length of small intestine is again taken from the lowest point of the abdomen and sewn to form a reservoir. The ureters from both kidneys are sewn into it, and it is sewn to the urethra. There is no artificial outlet and urination can take place naturally, since the urethral sphincter remains intact. The erectile nerves can also be preserved. The ileal neobladder is available for both men and women.
  The quality of life after a complete bladder removal can be preserved to the highest degree with an ileal neobladder.
  In the case of a tumour in the urethra, is it not possible to fashion an ileal neobladder, as the urethra itself has to be removed.
  If it is necessary to avoid a wet stoma despite the necessity of removing the urethra, techniques are available with a dry artificial catheterisable stoma; these involve attaching either a navel stoma or a lower abdominal stoma. They allow the patient to empty the bladder independently using a catheter. A dry stoma either involves invagination of an intestinal loop or the use of the appendix (appendix pouch).