Our surgeons are highly experienced in using a variety of approaches to preserve the quality of life of people with bladder cancer, including minimally invasive techniques and innovative methods to preserve urinary and sexual function. Because we operate as such a tightly integrated team, we can often move patients along to surgery much more quickly than other cancer centers.
Surgery for Bladder Cancer at Memorial Sloan Kettering
Your surgical team may recommend one or more of the following treatment approaches:
Urologic surgeon Bernard Bochner of Memorial Sloan Kettering discusses minimally invasive surgery and bladder reconstruction options.
Bladder cancer that is a transitional cell carcinoma (TCC) confined to the inner tissues of the bladder (stages 0 and I) typically calls for a minimally invasive procedure using a cystoscope. Your surgeon will insert this thin, lighted instrument through the urethra and into the bladder to remove tumors.
Our surgeons now employ a new imaging technology called Cysview®, which uses a fluorescent dye and a special blue light to detect cancer growths during a csytoscopy. This technology enables the surgeon to take out all cancerous tissue immediately rather than perform a follow-up procedure.
If you are at a high risk for recurrence of the cancer after surgery, we may recommend that you receive bacillus Calmette-Guérin (BCG) therapy. This procedure consists of inactivated tuberculosis bacteria being delivered directly to the bladder through a small tube, or catheter, placed in the urethra (the duct through which urine is transported out of the body). The delivery of drugs to the bladder in this way is called intravesical therapy.
Given once weekly for six weeks, BCG therapy triggers an inflammatory response in the bladder that prevents the tumor from growing. If you receive BCG therapy, our physicians will likely want to examine you every few months after your therapy ends to ensure that the bladder remains healthy and tumor-free.
In some cases, early-stage TCC bladder cancers do not respond to BCG therapy. If the bladder cancer returns despite BCG treatment, you may receive other drugs, including certain chemotherapy drugs, through intravesical therapy to lower the risk that the cancer returns. Our researchers are also evaluating new agents to treat noninvasive bladder cancers that do not respond to BCG therapy.
If you have muscle-invasive bladder cancer, our doctors may need to remove the bladder surgically in a procedure known as a cystectomy. Memorial Sloan Kettering’s urologic surgeons have extensive experience in this approach, performing a large number of these operations every year.
You will meet with both a medical oncologist and a surgeon before any treatment is prescribed. This ensures that experts in both specialties thoroughly evaluate your situation to determine the best approach.
When cancer has spread into or beyond the muscle layer of the bladder wall, removal of the entire bladder and other organs — called a radical cystectomy — often provides the best chance for a long-term cure. Our surgeons may also take out the surrounding lymph nodes to help prevent cancer from coming back or metastasizing (spreading) to other areas of the body.
In our male patients, a radical cystectomy also includes removal of the prostate and seminal vesicles — tube-like glands that are located behind the bladder and secrete many of the components of sperm. In females, the uterus, fallopian tubes, ovaries, anterior (front) vaginal wall, and urethra are removed.
Depending on your individual case, our surgeons may recommend minimally invasive surgery to perform the radical cystectomy. Done through small incisions — usually made in the abdominal wall — this approach is being evaluated for its ability to lead to fewer complications, less blood loss, a shorter hospital stay, and a quicker recovery than conventional open surgery.
For some patients, our surgeons recommend that the procedure be done through minimally invasive robotic surgery, in which special surgical instruments are connected to a robotic device and inserted through small incisions. The surgeon controls the instruments from a console in the operating room. Our doctors are actively investigating whether this approach helps to reduce complications during and after surgery.
Urinary Diversion through Ostomy and a Stoma
If the bladder is removed through cystectomy or radical cystectomy, our surgeons may create a new storage area for urine. In this procedure, known as an ostomy, urine is diverted through a segment of the small intestine called the ileum to create a passageway known as an ileal conduit.
One end of the ileal conduit forms an opening on the outside of the abdomen, usually on the lower right side. The end, which is visible on the surface of the skin, is called a stoma. Urine drains through this opening into a collection bag.
Our nurses have a great deal of expertise in caring for stomas after surgery and in helping patients learn how to change and empty the collection pouch.
Preservation of Sexual Function
Surgery for bladder cancer, as well as the illness itself, can sometimes affect sexual health. Memorial Sloan Kettering’s surgeons take precautions to preserve sexual function as much as possible. For some women, our surgeons use techniques that spare the vagina. For some men, our surgeons can use nerve-sparing techniques to maintain their ability to have an erection.