The therapy of bladder tumours depends on the individual stages. Tumours that do not grow muscle-invasively are resected transurethrally. The tumour is resected through the urethra with the help of an electrical loop and flushed out of the bladder.
The resection must be performed deep into the bladder layers in order to completely remove the tumour base. The individual tumor remnants and wall components are sent separately to histology to assess the exact spread of the tumor. In addition, it can be confirmed that the tumour has been completely removed from the bladder.
If this is not the case, a follow-up resection must be performed. If the tumour grows muscle-invasively or recurs, the bladder must be completely removed. A distinction is made between continental and incontinent surgical procedures.
In incontinent urinary drainage surgery, the two ureters are led into the small intestine and an outflow is formed from this. This is a procedure that is less complicated and can be performed more quickly and is therefore used in patients for whom a longer operation would not be reasonable. In the case of the continental surgical procedures, a further three possibilities can be distinguished.
- Firstly, part of the ileum can be formed into a new bladder and then reconnected to the kidney and urethra. Complications can include infections, incontinence, scarring and urinary transport problems. – Another possibility is urine diversion via the navel.
Here an ileocecal pouch is connected to the navel. The urine is drained by catheterisation once a year. This is done by the patient himself and is usually not painful.
Of course it takes some getting used to. – In the past, there was also the option of passing the urine into the intestine. However, this does not only cause the problem of very thin stool.
There is also a significantly increased risk of intestinal carcinoma, which is why an annual colonoscopy is necessary. If the bladder carcinoma has metastasised to other organs, the tumour is treated with chemotherapy. In the case of soft tissue or bone metastases, radiation therapy is often performed. This has a palliative-analgesic effect and is no longer used for healing.
