Bladder Cancer Surgery

Urologic oncologists use the latest technology to see non-muscle invasive bladder cancers more easily using blue-light cystoscopy with hexaminolevulinate HCl. 

In this approach, providers place a small amount of an imaging agent, hexaminolevulinate HCl, into the bladder through a catheter. Then, they put a cystoscope into the bladder through the urethra. The scope has both white and blue light. In the blue light, the imaging agent makes cancer cells glow pink. 

This technique allows oncologists to find and remove more of the bladder cancer. About 10% to 20% of bladder tumors are missed using the traditional white-light method.

Removing more cells also lowers the risk that the disease will come back (recur).

This is the most common first treatment for non-muscle invasive bladder cancer. Non-muscle invasive cancer sits on the inside surface of your bladder or within the first lining. The surgeon puts a thin camera (resectoscope) into your bladder through your urethra. Then, they use a special wire loop to remove as much of the tumor as they can get safely.

This is surgery for cancer that has gone into your bladder muscle. The surgeon removes your entire bladder. They also remove nearby lymph nodes to keep the cancer from spreading further. Other organs, like the prostate, uterus, fallopian tubes, ovaries or part of the vagina, may also be removed.

There are both open methods, which are done through a larger incision (cut), and robot-assisted methods, which are done through small incisions. Your care team will talk with you in advance about your exact procedure. 

Our urologic oncologists do many more of these surgeries each year than surgeons anywhere else in Washington state. This means your care team has a great deal of experience. Research clearly shows that higher-volume centers like ours have better outcomes. 

Some people with muscle-invasive cancer can avoid surgery to remove their bladder. Instead, they can have chemotherapy and radiation therapy. We also offer this bladder-sparing treatment in certain cases based on certain cancer features.

To allow urine to leave your body after radical cystectomy, surgeons will make a new drainage system. They do this using parts of your intestines. There are three options:

Orthotopic neobladder — The surgeon makes a new bladder that is connected to your urethra. You can urinate the same as you did before. 

Ileal conduit/loop — The surgeon makes an opening (stoma) in your abdomen. Urine can drain all the time into a pouch outside your body.

Continent cutaneous urinary reservoir — This is a storage system that you drain every few hours. You do this using a catheter that goes through an opening in your abdomen.

Fred Hutch and UW Medicine urologic oncologists do laparoscopic radical cystectomy using robotic technology. We did the first robot-assisted cystectomy in the region, and we lead the area in providing this type of care.

With this type of surgery, your surgeon uses hand and foot controls to move robotic arms. These arms hold a laparoscope (camera) and surgical tools. The system lets your surgeon make precise, complex motions and helps keep them from getting tired. This method is linked with less blood loss, less pain and better cosmetic results with the same success in cancer control.