When the tumour is invading the muscle of the bladder your doctor has to offer you a more radical treatment than transurethral resection of the tumour.
This could be medical or surgical treatment. The medical is either intravenous chemotherapy followed by radical radiotherapy or radical cystectomy, or radical cystectomy followed by chemo or radiotherapy. The best protocol to offer is selected / tailored and proposed to the patient on an individual basis related to several clinical data, results and patient’s choice.
Radical cystectomy is an operation performed by us in a robotically assisted laparoscopic approach that gives us the opportunity to remove in a male patient the bladder, the prostate, the lymphnodes and in a female one the bladder, the tubes, the uterus and the lymphnodes. The ureters are then sutured on a small piece of the gut is turned to the right side of the belly as a small stoma in order to collect the urine in a bag (this is called ileal conduit or Bricker).
In younger patients we could propose to use more gut and re-model a new bladder (neobladder) and suture it either in the original position (orthotopic) either in a new one (heterotopic).Feel free to discuss with your urologist all the details of each choice in order to be fully consented before to make one.