Bladder surgery covers several procedures, most often used to treat bladder tumours, chiefly three: transurethral resection of the tumour (TURBT), cystectomy, and radical cystectomy with urinary diversion. The treating team chooses the option according to the stage of the disease, and the aim is to remove the tumour or the affected bladder with as little effect on body function as possible.
In transurethral resection, the surgeon passes a scope through the urethra, without a skin incision, and scrapes away the tumour. Cystectomy is done under general anaesthesia by open, keyhole or robot-assisted surgery. In radical cystectomy, nearby organs and lymph nodes are also removed as needed, and a new route for urine is created, either a channel draining into an external bag or a replacement bladder.
Transurethral resection usually takes 30 to 60 minutes with a short hospital stay, while bladder removal takes several hours and the stay may last one to two weeks. Recovery from radical surgery generally takes roughly six to twelve weeks.
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It removes the tumour or the affected bladder, and may help control the disease and ease symptoms such as blood in the urine. A cure cannot be promised, as the treating team judges the outcome by the type and stage of the disease, and further treatment may be needed.
Transurethral resection suits superficial tumours and is also used for diagnosis. Bladder removal is considered for deeper or recurring tumours. The team decides after endoscopy, imaging, tests and an assessment of your general health.
You will have blood tests, imaging and an anaesthetic assessment. Tell the doctor about all your medicines, and never stop any of them, including blood thinners, on your own. Before bladder removal you may be offered counselling about the new urine route and care of the abdominal opening.
Transurethral resection uses a scope without a surgical cut. In cystectomy the bladder itself is removed, and in radical cystectomy nearby organs and lymph nodes may be removed as well. A urine route is then built, either with a bowel channel draining into an external bag or with a replacement bladder made from bowel.
These operations are done under general or spinal anaesthesia, so pain is not usually felt during them. Afterwards there is discomfort that painkillers can ease, and after transurethral resection there may be burning and slight blood in the urine.
After transurethral resection a urinary catheter may stay in for a few days, and strenuous activity is avoided for several weeks. After bladder removal the stay is longer, and recovery involves drainage tubes, training in caring for the new urine route, and gradual rehabilitation.
The result of transurethral resection is known from the pathology report after a few days, and the team builds a follow-up plan, often with regular cystoscopies. After radical surgery the result is judged by pathology and regular follow-up.
They include bleeding and urinary infection, and rarely a hole in the bladder wall during transurethral resection. Bladder removal adds infection, leakage from bowel joins, bowel obstruction, kidney problems, effects on sexual function, and clots in the leg or lung.
Transurethral resection usually leaves no visible scars. Bladder removal leaves abdominal scars, and a small opening for urine to drain into an external bag may remain if that route is chosen, whereas a replacement bladder usually has no such opening.
This is often a few days after transurethral resection, once the catheter is out and the condition is stable. After bladder removal it is usually two weeks or more, and the treating team sets the date after a follow-up check.
