Radical cystectomy /urinary diversion
If the diagnosed bladder tumor is a muscle-invasive tumor but limited to the urinary bladder, a tumor recurrence (after TUR bladder) of higher aggressiveness or if the tumor cannot be controlled by transurethral bladder tumor resection (TUR-B), the bladder must be surgically removed (= radical cystectomy). Patients with advanced findings and resulting complications such as bleeding can also be treated by urinary bladder removal.
In this procedure, the urinary bladder is removed while maintaining a safe distance. In men, both the prostate including seminal vesicles and in women the uterus and, depending on age, the fallopian tubes and ovaries are also removed. To prevent the tumor from spreading through the lymphatic system, the pelvic lymph nodes are also removed.
Since the urine reservoir urinary bladder is now missing, it must be determined before the operation how the urinary bladder replacement and thus the urine diversion will be designed after the operation. A distinction is made here between continent (replacement bladder/neobladder) and incontinent urinary diversion (artificial urinary outlet). Depending on the age and previous illness of the patient, a decision is made as to which surgical method makes the most sense and is associated with the fewest risks.
Complete removal of the bladder and draining lymph nodes means that muscle-invasive bladder tumors can be treated very well. The recurrence rate of bladder tumors is significantly reduced by the radical approach. However, affected patients have relatively minor limitations in quality of life despite the extensive surgery. Even with an incontinent urinary diversion, patients can participate in sports activities, swimming or sauna sessions.