Surgery is the main treatment for noninvasive bladder cancer and an important option for invasive bladder cancer. Some people with invasive cancer can have chemotherapy and radiation therapy without surgery to remove their bladder (bladder-sparing treatment). SCCA patients have surgery at University of Washington Medical Center.
Blue light cystoscopy (BLC) with Cysview
This is a state-of-the-art drug/device technology used in the OR that helps providers better see non-muscle invasive bladder cancer (NMIBC) tumors when they look into the bladder. We are the first site to offer this technology in Washington.
- BLC with Cysview uses a cystoscope equipped with both white and blue light.
- Before the procedure, a small amount (less than 2 oz.) of the prescription imaging agent Cysview is placed into the bladder using a catheter.
- Cysview makes the bladder cancer tumors glow pink in blue light, thus allowing providers to detect significantly more bladder cancer in patients (10-20 percent of bladder tumors are missed using traditional white light cystoscopy).
- BLC with Cysview supports a more complete resection, reducing recurrence rates by 20 percent and prolonging recurrence-free survival.
Transurethral resection of a bladder tumor (TUR or TURBT)
This is the most common primary treatment for noninvasive bladder cancer, which sits on the inside surface of your bladder or within the first lining.
- The doctor inserts a thin camera (resectoscope) into your bladder through your urethra.
- Then the doctor uses a special wire loop to remove (resect) as much of the tumor as can be done safely.
This surgery is used for cancer that has invaded your bladder muscle.
- The surgeon removes your entire bladder and nearby lymph nodes to keep the cancer from spreading.
- In men, the prostate is also removed.
- In women, the uterus, fallopian tubes, ovaries and part of the vagina may be removed.
There are both open (through a larger incision) and laparoscopic (through small incisions) approaches to removing the bladder, and you might have either type of surgery.
To allow urine to exit your body after radical cystectomy, surgeons reconstruct a drainage system using portions of your intestines that have been separated from the rest of your intestines. There are three options:
- Ileal conduit/loop — The surgeon makes an opening (stoma) in your abdomen so urine can drain continuously into a pouch on the outside.
- Orthotopic neobladder — This involves constructing a new bladder that’s connected to your urethra so you can urinate as you did before. SCCA and UW Medicine surgeons pioneered techniques for creating a neobladder from a section of intestine.
- Continent cutaneous urinary reservoir — This is a storage system that you drain every few hours using a catheter inserted through an opening in your abdomen.
Robot-assisted surgery for bladder cancer
SCCA and UW Medicine urologic surgeons perform laparoscopic radical cystectomy using robotic technology called the da Vinci Surgical System. We performed the first robot-assisted cystectomy in the region in both men and women, and we lead the area in providing this type of care.
- Your surgeon uses hand and foot controls to move robotic arms that hold a laparoscope (camera) and surgical instruments.
- The system allows your surgeon to perform very precise, complex motions and helps prevent fatigue.
- Robot-assisted surgery is associated with less blood loss, less pain and better cosmetic results with preserved cancer control.