Intravesical Drugs for Non-Muscle-Invasive Bladder Cancer

August 26, 2026/0 Comments/in Bladder Surgery, Blog Post/by drjo

Treating the tumour and reducing the risk of it coming back

Bladder cancer has an inconvenient habit: even after a visible tumour has been completely removed, new tumours can sometimes return elsewhere in the bladder.

For selected patients with non-muscle-invasive bladder cancer (NMIBC), previously often called superficial bladder cancer, Mitomycin C can be placed directly into the bladder to destroy residual cancer cells and reduce the chance of recurrence. It is one of the therapies available. It will be discussed on its own.

This treatment is called intravesical Mitomycin C.

The advantage of intravesical treatment is rather elegant: instead of sending chemotherapy around the entire body, the medication is delivered directly to the bladder lining where it is needed.

What is Mitomycin C?

Mitomycin C is an anti-cancer chemotherapy medication originally derived from Streptomyces bacteria.

When used for bladder cancer, the medication is usually introduced directly into the bladder through a urinary catheter rather than being given intravenously.

This allows a relatively high concentration of chemotherapy to come into direct contact with the urothelium while limiting systemic exposure.

Intravesical Mitomycin is used particularly following transurethral resection of bladder tumour (TURBT) and in selected patients requiring an induction course of intravesical chemotherapy.

Why is Mitomycin C used?

The first and most important treatment for most visible non-muscle-invasive bladder tumours is a TURBT.

During TURBT, the visible tumour is removed and tissue is sent to pathology to determine:

tumour type
tumour grade
depth of invasion
presence or absence of carcinoma in situ (CIS)
whether muscle is present in the specimen
whether cancer has invaded the bladder muscle.

The pathology results allow the tumour to be classified into a recurrence and progression risk category.

Mitomycin C may then be recommended to reduce the risk of tumour recurrence.

When is Mitomycin C used?

There are several different situations in which intravesical Mitomycin C may be considered.

1. A single dose immediately after TURBT

In appropriately selected patients, a single dose of intravesical chemotherapy can be given following TURBT.

Australian eviQ guidance describes administration within 24 hours and preferably within six hours of TURBT. AUA guidance similarly recommends considering a single postoperative instillation within 24 hours for suspected or known low- or intermediate-risk disease.

The purpose is to destroy:

microscopic tumour cells remaining after resection
free-floating tumour cells released during surgery
tumour cells that might otherwise implant elsewhere on the bladder lining.

Think of TURBT as removing the weeds you can see, while the immediate intravesical treatment targets some of the microscopic seeds left behind.

Importantly, a single postoperative instillation primarily reduces recurrence. It has not been shown to provide the same benefit for progression or survival.

2. Induction Mitomycin C

Some patients with intermediate-risk NMIBC may benefit from a course of intravesical chemotherapy rather than a single treatment.

A commonly used regimen is:

Mitomycin C once weekly for six weeks.

Australian eviQ protocols include a six-week induction course for appropriate patients with Ta, T1 or CIS-containing urothelial carcinoma classified as intermediate risk, as an alternative to BCG in selected circumstances.

The exact treatment schedule should be individualised according to:

tumour grade
pathological stage
tumour size
number of tumours
previous recurrence rate
previous intravesical therapy
presence of CIS
tolerance of treatment
overall risk of progression.

What about aggressive superficial bladder cancer?

The term “superficial bladder cancer” can be misleading.

A cancer can remain confined to the bladder lining or lamina propria and still behave aggressively.

Higher-risk features include:

high-grade urothelial carcinoma
T1 disease
carcinoma in situ
multiple tumours
large tumours
frequently recurrent disease
certain adverse pathological features.

For genuinely high-risk NMIBC, particularly high-grade T1 disease and CIS, intravesical BCG immunotherapy generally has a central role when bladder preservation is appropriate.

Mitomycin C should therefore not automatically be regarded as a substitute for BCG in every patient with aggressive NMIBC.

Treatment needs to be based on the patient’s pathological risk group and previous response to therapy.

In selected circumstances, Mitomycin may nevertheless be considered, including when BCG is unsuitable, poorly tolerated, unavailable or as part of specific sequential intravesical treatment protocols.

Patients with very-high-risk disease also require discussion about whether bladder-preserving intravesical treatment remains appropriate or whether radical cystectomy should be considered.

How does Mitomycin C work?

Mitomycin C is an alkylating anti-tumour agent.

After entering a cancer cell, the drug is activated and produces reactive metabolites that bind to DNA.

It causes cross-linking of DNA strands, preventing the DNA from separating normally.

As a result, the cancer cell has difficulty:

replicating its DNA
dividing
repairing damaged DNA
continuing normal cellular function.

Ultimately, susceptible tumour cells die.

Because Mitomycin is placed directly into the bladder, it can attack residual malignant cells while generally producing much less systemic exposure than intravenous chemotherapy.

What happens during treatment?

Intravesical treatment is usually performed as an outpatient procedure.

A small urinary catheter is passed through the urethra into the bladder.

The bladder is emptied completely and the Mitomycin solution is then introduced through the catheter.

The catheter may then be removed or temporarily clamped, depending upon the treatment protocol.

The medication is usually retained within the bladder for approximately one to two hours.

Patients are generally advised to restrict fluids beforehand so that the medication is not excessively diluted. Australian eviQ protocols advise restricting fluids for approximately four to six hours before and during treatment, with appropriate adjustment of diuretic medication where relevant.

After the prescribed treatment period, the medication is passed out with the urine or drained through the catheter.

Side effects of intravesical Mitomycin C

Most patients tolerate treatment reasonably well because relatively little of the medication is normally absorbed into the bloodstream.

The commonest problems involve irritation of the bladder.

Chemical cystitis

Mitomycin can irritate the bladder lining and cause:

burning when passing urine
urinary frequency
urgency
bladder discomfort
pelvic discomfort
mild haematuria.

These symptoms frequently develop within hours of treatment and usually settle over the following few days.

Urinary tract infection

A urinary infection can occasionally occur following catheterisation.

Symptoms may include:

increasing dysuria
cloudy or offensive urine
fever
chills
worsening urinary frequency
feeling generally unwell.

A urine culture may be required if infection is suspected.

Skin irritation

Mitomycin is a cytotoxic medication and contact with the skin should be avoided.

Urine containing residual medication may irritate the skin around the urethra or genital area.

Patients should therefore follow the specific hygiene and toilet precautions provided by their treating unit.

Allergic reaction

Hypersensitivity reactions are uncommon but possible.

Symptoms can include:

skin rash
itching
facial redness
wheezing
breathlessness
dizziness
fever or chills.

Severe allergic reactions are rare but require urgent medical attention.

Less common but important complications

Although uncommon, Mitomycin can occasionally produce significant complications.

Severe chemical cystitis

Repeated bladder irritation can occasionally become severe.

Persistent inflammation may lead to:

chronic bladder pain
reduced bladder capacity
bladder fibrosis
rarely, bladder contraction.

Patients who already have a small-capacity bladder require particular caution because of the potential risk of further bladder contraction.

Extravasation

One of the most important complications is Mitomycin extravasation.

This means that Mitomycin escapes through an injured or perforated bladder wall into the surrounding tissues.

Although rare, this can produce significant tissue injury.

Reported complications include:

severe pelvic inflammation
tissue necrosis
abscess formation
bladder injury
fistula formation
damage to surrounding genital tissues.

Symptoms can occur immediately, but importantly they may also appear weeks or even months after treatment. Persistent or unexplained pelvic or abdominal pain following intravesical Mitomycin therefore deserves investigation.

An important precaution after TURBT

Intravesical Mitomycin should not simply be administered automatically following every TURBT.

If there is any suspicion that the bladder has been perforated, the medication should not be given.

AUA guidance advises against postoperative intravesical chemotherapy following a suspected perforation or extensive resection. Australian eviQ guidance similarly excludes postoperative Mitomycin when bladder perforation has occurred.

This is important because chemotherapy escaping through a bladder perforation can cause substantial tissue injury.

When should Mitomycin treatment be postponed?

Intravesical Mitomycin is generally avoided or postponed in the presence of:

visible haematuria
confirmed urinary tract infection
traumatic catheterisation
fever or unexplained febrile illness
known allergy to Mitomycin
suspected or confirmed bladder perforation
significant bladder injury following surgery.

Australian protocols specifically advise against treatment following traumatic catheterisation, with visible haematuria, active UTI or recent bladder injury.

If catheterisation is traumatic or produces bleeding on the day of treatment, the treatment is usually deferred.

Does Mitomycin cause the usual chemotherapy side effects?

Usually not.

Because the medication is placed into the bladder rather than routinely given intravenously, systemic absorption is generally very low.

Therefore classic chemotherapy problems such as:

hair loss
severe nausea
widespread immunosuppression
profound fatigue
bone marrow suppression

are unusual with standard intravesical therapy.

Systemic absorption can occur rarely, however, particularly when the bladder lining has been significantly disrupted. Myelosuppression is considered a potential but uncommon complication, and a full blood count may be appropriate if a patient becomes unexpectedly systemically unwell.

Precautions after treatment

Mitomycin remains a cytotoxic chemotherapy drug, even when delivered directly into the bladder.

Patients should therefore follow their treating unit’s instructions carefully regarding:

toilet hygiene
handling urine
washing contaminated skin
hand washing
fluid intake following treatment
management of contaminated clothing.

Patients should also tell their treating team about all medications they are taking and whether they are receiving antibiotics, diuretics or other cancer treatments.

When should you seek urgent medical advice?

Contact your treating team promptly if you develop persistent or worsening urinary symptoms after treatment.

More urgent assessment is required for symptoms such as:

temperature of 38°C or higher
inability to pass urine
significant or persistent haematuria
severe pelvic or abdominal pain
chills or shaking
shortness of breath
severe rash or suspected allergic reaction
persistent symptoms that are worsening rather than settling.

Severe pelvic or abdominal pain following intravesical Mitomycin is particularly important because, although uncommon, it may indicate bladder injury or extravasation.

Mitomycin does not replace surveillance

One of the most important points about NMIBC is that successful treatment does not mean surveillance can stop.

Even after apparently complete removal and intravesical chemotherapy, urothelial tumours can recur.

Depending upon the original tumour’s risk category, ongoing surveillance may include:

flexible cystoscopy
urine cytology
repeat TURBT
upper urinary tract imaging
further intravesical treatment.

Patients with higher-risk disease require considerably closer surveillance than those with a solitary low-grade tumour.

Mitomycin C versus BCG

These treatments are sometimes discussed together, but they work differently.

Mitomycin C is chemotherapy. It directly damages the DNA of susceptible tumour cells.

BCG is immunotherapy. It stimulates a local immune response within the bladder that attacks urothelial cancer cells.

The appropriate treatment depends upon the biological behaviour and risk category of the tumour.

For some patients, Mitomycin provides an effective and relatively well-tolerated strategy for reducing recurrence. For patients with higher-risk disease, BCG or more aggressive treatment may be preferable.

The important question is therefore not simply:

“Mitomycin or BCG?”

It is:

“What is the risk of this particular bladder cancer recurring or progressing, and which treatment provides the safest and most effective way of reducing that risk?”

The Bottom Line

Intravesical Mitomycin C is an established treatment for selected patients with non-muscle-invasive urothelial carcinoma of the bladder.

It may be used as a single treatment immediately following TURBT or as a course of intravesical chemotherapy in appropriately selected patients.

By placing chemotherapy directly into the bladder, Mitomycin can destroy residual cancer cells and reduce tumour recurrence while limiting exposure of the rest of the body.

Most side effects are related to temporary bladder irritation. Serious complications such as bladder injury, extravasation, fibrosis and tissue necrosis are uncommon but important, which is why careful patient selection and attention to precautions are essential.

And perhaps the most important message: Mitomycin reduces risk. It does not make follow-up optional.

Bladder cancer has a reputation for making return appearances, so regular cystoscopic surveillance remains an essential part of treatment.

This information is intended for general education and should not replace individual medical advice. Treatment of non-muscle-invasive bladder cancer should be tailored to the tumour’s stage, grade and recurrence/progression risk, previous treatments and the individual patient’s circumstances.

Intravesical Therapy for High-Risk Bladder Cancer

August 26, 2026/0 Comments/in Bladder Surgery, Blog Post/by drjo

BCG treatment, what is it?

BCG, short for Bacillus Calmette–Guérin, is one of the most effective treatments available for high-risk non-muscle-invasive bladder cancer (NMIBC).

BCG is best known as a vaccine originally developed against tuberculosis. In bladder cancer, however, it is used in a very different way. Rather than being injected as a vaccination, a solution containing BCG is placed directly into the bladder through a fine urinary catheter.

BCG is not conventional chemotherapy. It is a form of local immunotherapy. Its purpose is to stimulate the body’s immune system inside the bladder so that immune cells recognise and attack remaining bladder cancer cells.

For appropriately selected patients, BCG can significantly reduce the risk of bladder cancer returning and, importantly, reduce the risk of progression to more invasive disease.

Which bladder cancers are treated with BCG?

BCG is primarily used for high-risk or locally aggressive non-muscle-invasive urothelial carcinoma following adequate transurethral resection of the bladder tumour (TURBT).

Typical indications include:

Carcinoma in situ (CIS or Tis)
High-grade Ta urothelial carcinoma, particularly when large, multifocal or recurrent
High-grade T1 urothelial carcinoma
Recurrent high-grade non-muscle-invasive bladder cancer
Selected patients with multiple adverse pathological features
Selected patients with urothelial CIS involving the prostatic urethra as part of a bladder-preserving strategy

Current international guidelines recommend a six-week induction course of BCG for high-risk NMIBC, followed by maintenance treatment in patients who respond.

BCG is generally not required for a solitary low-risk, low-grade Ta bladder tumour. These cancers have a different biological behaviour and are usually managed with TURBT, sometimes combined with immediate intravesical chemotherapy and subsequent surveillance.

Why is BCG particularly important for carcinoma in situ?

Carcinoma in situ (CIS) deserves special attention.

Unlike the familiar papillary bladder tumour that projects into the bladder cavity, CIS can appear as a relatively flat, red or velvety abnormality of the bladder lining. Despite looking less dramatic, it is biologically aggressive.

CIS has a significant risk of recurrence and progression to muscle-invasive bladder cancer if inadequately treated. It cannot simply be “scraped away” by TURBT and forgotten.

For this reason, CIS generally requires either:

BCG immunotherapy
or, in selected very-high-risk circumstances,
radical cystectomy.

BCG produces substantially better response rates for CIS than intravesical chemotherapy in appropriate patients and has been shown to reduce the risk of progression.

How does BCG actually work?

The mechanism is fascinating because BCG does not simply poison cancer cells in the way traditional chemotherapy does.

Think of it less as dropping a bomb on the tumour and more as turning on the bladder’s local security system.

After BCG is introduced into the bladder, organisms interact with the urothelial surface and tumour cells. This produces a strong local inflammatory and immune response.

The process includes:

BCG attachment and internalisation

BCG interacts with urothelial cells, tumour cells and immune cells within the bladder.

Activation of innate immunity

Neutrophils, macrophages, dendritic cells and other immune cells are recruited into the bladder.

Cytokine release

A complex inflammatory signalling response develops, involving multiple cytokines and chemokines.

Activation of adaptive immunity

T lymphocytes and other components of the immune system become involved in recognising and destroying malignant urothelial cells.

The end result is an intentionally stimulated immune environment that makes the bladder a considerably less comfortable neighbourhood for residual cancer cells.

Before starting BCG

Successful BCG treatment starts with adequate staging and tumour clearance.

Patients will usually have undergone TURBT with pathological assessment confirming the tumour grade and stage.

In high-grade T1 disease, a repeat or second-look TURBT is frequently recommended to ensure complete resection and exclude previously unrecognised muscle-invasive disease.

Depending upon the tumour characteristics, assessment may also include:

Urine cytology
CT urography or other upper urinary tract imaging
Repeat cystoscopy
Re-resection of the original tumour site
Assessment of the prostatic urethra in selected patients
Review of pathology where variant histology or unusual findings are present

Very-high-risk cases are increasingly appropriate for multidisciplinary discussion because some patients may benefit more from early radical cystectomy than prolonged attempts at bladder preservation.

How is BCG given?

BCG is administered as an outpatient procedure.

A small catheter is gently passed through the urethra into the bladder. After the bladder has been drained, the BCG solution is instilled through the catheter.

The catheter is then removed unless there is a particular reason for it to remain temporarily.

The BCG solution is generally retained within the bladder for approximately two hours, where tolerated.

Patients receive specific instructions regarding fluid intake before treatment and safe handling of urine afterwards because BCG contains live attenuated Mycobacterium bovis.

The standard induction course

The traditional induction course consists of:

BCG once weekly for six weeks

This remains the standard initial regimen for high-risk disease.

Importantly, attempts to substantially reduce the number of induction and maintenance instillations have resulted in inferior cancer control. The six-week induction course therefore remains an important part of established treatment.

What happens after the first six treatments?

Following induction BCG, the bladder is reassessed.

This will generally involve:

Cystoscopy
Urinary cytology
Biopsy or repeat TURBT if an abnormality is detected
Additional investigation when cytology remains suspicious despite a normal-looking bladder

The key question is simple:

Has the cancer responded?

If it has, the next step is usually maintenance BCG.

Maintenance BCG

BCG works better in high-risk bladder cancer when appropriate maintenance treatment is added rather than simply giving six doses and stopping.

A widely used maintenance schedule consists of:

Induction

Once weekly × 6 weeks

followed by:

Maintenance

Once weekly × 3 weeks at:

3 months
6 months
12 months
18 months
24 months
30 months
36 months

This is often referred to as a SWOG-style maintenance schedule.

Current European guidance recommends full-dose BCG for one to three years in high-risk disease, with the benefit of years two and three balanced against toxicity, patient tolerance and BCG availability. Three years of maintenance provides additional protection against recurrence in high-risk patients compared with one year.

Not every patient will receive every planned dose. Treatment may need to be delayed, reduced or discontinued because of side effects, infection, BCG availability or changes in the cancer.

When should BCG NOT be given?

Because BCG contains live attenuated bacteria, certain precautions are essential.

BCG should not be administered:

Within the first two weeks after TURBT
When there is visible haematuria
Following traumatic catheterisation
In the presence of a symptomatic urinary tract infection

Treatment should instead be delayed until it can be administered safely.

Additional caution is required in significantly immunocompromised patients, and individual circumstances should be discussed with the treating urologist.

Common side effects of BCG

BCG deliberately produces inflammation within the bladder, so some urinary symptoms are expected.

The most common side effects include:

Urinary frequency and urgency

Patients may feel the need to urinate frequently or suddenly.

Burning during urination

Mild-to-moderate dysuria is common for a day or two following treatment.

Blood in the urine

A small amount of haematuria can occur.

Bladder discomfort

Some patients describe suprapubic discomfort, cramping or a sensation resembling cystitis.

Flu-like symptoms

Fatigue, muscle aches, chills and a low-grade temperature can occur as the immune system responds to treatment.

These symptoms usually settle within approximately 24–48 hours.

The bladder may complain rather loudly about BCG, but mild short-lived irritation is usually part of the intended inflammatory response rather than evidence that something has gone wrong.

When should you contact your urologist?

Patients should contact their treating team if symptoms are unusually severe or fail to settle.

Particular attention should be paid to:

Persistent fever
High fever or rigors
Severe urinary symptoms
Inability to pass urine
Persistent or heavy haematuria
Significant deterioration in general wellbeing
Symptoms continuing substantially longer than expected

Persistent fever after BCG deserves particular attention.

Serious complications of BCG

Serious complications are uncommon, but they are important because BCG contains viable attenuated bacteria.

Potential complications include:

Severe BCG cystitis

Persistent bladder inflammation may occasionally become sufficiently troublesome that treatment needs to be delayed or discontinued.

Granulomatous prostatitis

BCG can produce an inflammatory reaction within the prostate. This can occasionally produce an abnormal prostate examination or elevated PSA and may mimic prostate cancer clinically.

Epididymo-orchitis

Rarely, BCG-related inflammation or infection can involve the epididymis or testis.

Upper urinary tract involvement

Granulomatous infection of the kidney is uncommon but recognised.

BCG infection

Localised or systemic infection with Mycobacterium bovis can occur.

BCG sepsis

This is a rare but potentially life-threatening complication.

A patient who becomes systemically unwell with persistent high fever, rigors, hypotension, respiratory symptoms or other features of sepsis following BCG requires urgent medical assessment.

Treatment may require hospital admission, infectious diseases involvement, anti-mycobacterial therapy and other supportive treatment.

BCG should therefore be respected. It is an extraordinarily useful treatment, but it is not simply another bladder wash.

What if BCG is poorly tolerated?

Treatment does not always have to proceed according to the calendar regardless of symptoms.

Depending upon severity, management can include:

Postponing the next instillation
Symptomatic treatment
Investigation for bacterial urinary infection
Assessment for BCG-related infection
Dose modification in selected circumstances
Discontinuation of BCG when toxicity becomes unacceptable

Persistent significant symptoms should be assessed rather than repeatedly giving further BCG and hoping the bladder eventually stops protesting.

What if the cancer returns after BCG?

This is one of the most important aspects of BCG treatment.

Not every recurrence after BCG means the same thing. The timing, pathology and amount of previous BCG exposure all matter.

Terms such as:

BCG-exposed
BCG-relapsing
BCG-refractory
BCG-unresponsive

describe different clinical situations.

Of these, BCG-unresponsive disease is particularly important because these tumours are unlikely to benefit from simply giving more BCG.

Current guidelines recommend radical cystectomy as the oncologically preferred treatment for appropriate patients with BCG-unresponsive high-grade disease.

When should radical cystectomy be considered?

BCG is intended to preserve the bladder, but preserving the bladder should never become more important than controlling the cancer.

Early radical cystectomy should be discussed in patients with very-high-risk features such as:

Persistent high-grade T1 disease
Recurrent high-grade disease despite adequate BCG
BCG-unresponsive disease
T1 disease associated with CIS
Certain variant histologies
Lymphovascular invasion
Extensive or multifocal high-grade disease
Other features suggesting a particularly high risk of progression

For very-high-risk NMIBC, current EAU guidance recommends discussing radical cystectomy upfront. BCG for one to three years remains an option for appropriately selected patients, particularly those who decline cystectomy or are medically unsuitable for major surgery.

Delaying cystectomy in a biologically aggressive tumour that is clearly failing BCG may compromise cancer outcomes.

Are there alternatives when BCG fails?

For patients with BCG-unresponsive disease who are unable or unwilling to undergo radical cystectomy, bladder-preserving alternatives are evolving rapidly.

Depending upon availability, tumour characteristics and local regulatory approval, options may include:

Sequential intravesical gemcitabine/docetaxel
Other intravesical chemotherapy combinations
Novel intravesical therapies
Systemic immunotherapy for selected CIS
Gene-based intravesical therapy in jurisdictions where available
Device-assisted intravesical therapy
Clinical trials

These treatments should not automatically be considered equivalent substitutes for radical cystectomy in a surgically fit patient with genuinely BCG-unresponsive aggressive disease. The risk of progression needs to remain at the centre of the decision.

Surveillance after BCG

BCG treatment does not eliminate the need for careful surveillance.

High-risk bladder cancer requires long-term follow-up because recurrence can occur even after an excellent initial response.

Follow-up generally involves:

Cystoscopy + urine cytology

initially at approximately 3 months, with subsequent surveillance determined by tumour risk and previous findings.

High-risk patients typically undergo frequent cystoscopy during the first two years, with gradually increasing intervals thereafter if they remain disease-free.

Periodic upper urinary tract imaging is also appropriate because high-risk urothelial carcinoma can occasionally develop within the ureters or kidneys.

Surveillance is usually long term and, for high-risk disease, often lifelong.

A practical BCG pathway

A typical pathway for high-risk non-muscle-invasive urothelial carcinoma is:

TURBT

↓

Histological confirmation of high-risk NMIBC

↓

Repeat TURBT when indicated, particularly high-grade T1 disease

↓

BCG induction: weekly × 6

↓

Cystoscopy + cytology and assessment of response

↓

If responding:

Maintenance BCG

3 weekly treatments at 3, 6 and 12 months, with continued maintenance to as long as 36 months in appropriate high-risk patients.

↓

Long-term cystoscopic surveillance

If persistent or recurrent high-grade disease:

Re-stage the bladder and determine whether the tumour represents BCG-unresponsive disease.

↓

Discuss radical cystectomy versus carefully selected bladder-preserving alternatives/clinical trials where appropriate.

The bottom line

Intravesical BCG remains a cornerstone of treatment for high-risk non-muscle-invasive urothelial carcinoma of the bladder.

Its strength lies in stimulating a powerful local immune response that reduces recurrence and helps prevent progression of aggressive superficial bladder cancer.

The usual treatment begins with six weekly instillations, followed by maintenance therapy for appropriately responding high-risk patients.

But BCG is not appropriate for every bladder tumour, and it should not be continued indefinitely when aggressive cancer is clearly failing treatment.

The most important principle is therefore not simply:

“Can we preserve the bladder?”

It is:

“Can we preserve the bladder safely without compromising cancer control?”

For patients with very-high-risk or BCG-unresponsive disease, timely discussion of radical cystectomy can be every bit as important as the BCG treatment itself.

This information is intended as general patient education and does not replace individual assessment by a urologist. BCG protocols, product availability and management of BCG-resistant disease may vary between patients and treatment centres.

Superficial Urothelial Carcinoma of the Bladder

August 26, 2026/0 Comments/in Bladder Surgery, Blog Post/by drjo

Understanding non-muscle-invasive bladder cancer, TURBT, intravesical therapy and long-term surveillance

Being told that you have a bladder tumour is understandably alarming. The reassuring part is that many bladder cancers are discovered while they are still confined to the inner layers of the bladder and have not invaded the bladder muscle.

This is called non-muscle-invasive bladder cancer (NMIBC), historically referred to as superficial bladder cancer. NMIBC includes Ta tumours, T1 tumours and carcinoma in situ (CIS). These tumours behave very differently depending on their stage, grade and other pathological features, so treatment is tailored according to the risk of the cancer coming back (recurrence) or becoming more aggressive (progression).

The good news is that most NMIBC can initially be treated through the urethra without making an incision in the abdomen. The less convenient news is that bladder cancer has a habit of returning, which is why careful surveillance becomes an important part of treatment.

What is urothelial carcinoma?

The inside of the bladder is lined by specialised cells called urothelial cells. Cancer arising from these cells is known as urothelial carcinoma.

Urothelial carcinoma can develop anywhere along the urinary tract, including the:

renal collecting system
ureters
bladder
urethra

The bladder is by far the most common site.

When a bladder tumour has not invaded the muscular wall of the bladder, it is classified as non-muscle-invasive bladder cancer.

What causes bladder cancer?

There is rarely one identifiable cause. Instead, bladder cancer develops following genetic changes within urothelial cells, often influenced by environmental exposures over many years.

Smoking

Cigarette smoking is the most important preventable risk factor for bladder cancer.

Chemicals absorbed through cigarette smoke enter the bloodstream, are filtered by the kidneys and eventually become concentrated in the urine. The bladder lining is therefore repeatedly exposed to these carcinogens.

Stopping smoking after a bladder cancer diagnosis is strongly encouraged.

Other risk factors

These include:

increasing age
occupational exposure to certain industrial chemicals
previous pelvic radiotherapy
previous treatment with cyclophosphamide
chronic urinary tract irritation in selected circumstances
a personal history of urothelial carcinoma

Sometimes there is no obvious risk factor at all.

How does bladder cancer present?

Blood in the urine

The classic presentation is haematuria, or blood in the urine.

This may be:

Visible haematuria

The urine may suddenly become:

pink
red
burgundy
tea-coloured
or contain blood clots

Importantly, bleeding from a bladder tumour is frequently painless and intermittent.

The bleeding may disappear completely for days, weeks or even months. Its disappearance does not necessarily mean that the underlying problem has resolved.

Unexplained visible haematuria should always be investigated.

Microscopic haematuria

Sometimes blood is detected only on urine testing and cannot be seen with the naked eye.

Other possible symptoms

Some patients, particularly those with carcinoma in situ (CIS), may experience bladder irritation rather than obvious bleeding.

Symptoms can include:

urinary frequency
urgency
burning when passing urine
nocturia
pelvic or bladder discomfort
recurrent symptoms resembling a urinary tract infection

Persistent urinary symptoms with repeatedly negative urine cultures may therefore warrant further investigation.

Investigating suspected bladder cancer

The investigation usually involves a combination of urine testing, imaging and direct examination of the bladder.

Urine testing

A urine sample may be checked for:

blood
infection
inflammatory cells
abnormal malignant cells

Urine cytology

Urine cytology examines cells shed from the urinary tract under a microscope.

It is particularly useful for detecting high-grade urothelial carcinoma and CIS, but is considerably less sensitive for low-grade tumours.

A negative cytology therefore does not exclude bladder cancer.

Imaging the urinary tract

Patients with haematuria may require imaging of the kidneys, ureters and bladder.

Depending on the clinical circumstances, this may include:

renal tract ultrasound
CT urinary tract imaging
CT urography

CT urography is particularly useful when investigating haematuria because urothelial carcinoma can occasionally arise within the renal collecting system or ureters as well as the bladder.

Cystoscopy

A cystoscopy allows the urologist to look directly inside the bladder.

A thin flexible telescope is passed through the urethra, usually under local anaesthetic.

Most bladder tumours have a characteristic appearance. They may resemble delicate fronds, seaweed or a tiny underwater cauliflower attached to the bladder wall.

Flat lesions such as CIS can be much more difficult to see.

If a suspicious lesion is identified, the next step is usually a transurethral resection of bladder tumour (TURBT).

TURBT: biopsy and removal of the bladder tumour

TURBT stands for:

Transurethral Resection of Bladder Tumour

This procedure serves two important purposes:

Treatment: removing all visible tumour where possible.
Diagnosis and staging: providing tissue for the pathologist to determine exactly what type of tumour is present and how deeply it has invaded.

The procedure is usually performed under general or spinal anaesthesia.

A telescope called a resectoscope is passed through the urethra into the bladder. The tumour is carefully removed, usually using an electrical or bipolar resection system.

There is therefore generally no external incision or abdominal scar.

Why obtaining bladder muscle matters

An adequate TURBT should establish how deeply the tumour extends.

For many tumours, particularly T1 and high-grade lesions, the specimen should contain muscularis propria (detrusor muscle) so that the pathologist can determine whether the cancer has reached the muscle layer. The pathological report should document the presence and involvement of muscularis propria where applicable.

This distinction dramatically changes treatment.

Understanding bladder cancer staging

A simplified view of the bladder wall is:

Urine

↓

Urothelium

↓

Lamina propria

↓

Detrusor muscle

↓

Fat surrounding the bladder

The important early stages are:

Ta

The tumour is confined to the urothelial surface and has not invaded the supporting tissue underneath.

Tis: carcinoma in situ

CIS is a flat, high-grade malignant lesion confined to the urothelium.

Unlike the typical papillary bladder tumour, CIS may be difficult to identify visually.

Despite being superficial anatomically, CIS is biologically aggressive and requires appropriate treatment.

T1

The tumour has invaded into the lamina propria, but has not invaded the muscularis propria.

T1 disease, particularly high-grade T1 disease, carries a greater risk of recurrence and progression.

T2

The cancer has invaded the bladder muscle.

Once muscle invasion is identified, the disease is no longer classified as NMIBC and requires a different treatment pathway.

Stage and grade are not the same thing

This distinction frequently causes confusion.

Stage describes how deeply the cancer has travelled into the bladder wall.

Grade describes how abnormal and biologically aggressive the cancer cells appear under the microscope.

A tumour may therefore be superficial but still be high grade.

Broadly, urothelial tumours are classified as:

Low grade

These generally grow more slowly and have a relatively low risk of progressing to muscle-invasive cancer, although they may recur.

High grade

These cells look significantly abnormal and have a greater potential for:

recurrence
invasion
progression
spread beyond the bladder

Risk stratification

Following TURBT, the tumour is classified into a risk category.

Risk assessment considers factors such as:

stage
grade
tumour size
number of tumours
previous recurrence rate
presence of CIS
T1 disease
pathological features including lymphovascular invasion
certain variant histological subtypes

This classification helps determine whether the patient requires:

TURBT alone → intravesical chemotherapy → BCG → or, in selected very-high-risk situations, consideration of radical cystectomy.

Modern guidelines emphasise risk-adapted rather than one-size-fits-all management.

Do I need another TURBT?

Sometimes.

A second-look or re-staging TURBT may be recommended when:

the initial tumour was incompletely removed
adequate muscle was not present in an important specimen
high-grade disease is present in selected circumstances
T1 disease is identified
there is concern that the original tumour may have been understaged
certain variant histologies are identified

The aim is to ensure that residual tumour has not been left behind and, crucially, that muscle-invasive disease has not been missed.

Intravesical treatment

Intravesical simply means that medication is placed directly into the bladder through a catheter.

This allows the treatment to come into direct contact with the bladder lining while reducing systemic exposure compared with intravenous chemotherapy.

Two important treatments are:

Mitomycin C

and

BCG

They are not interchangeable and are used for different risk groups.

Intravesical Mitomycin C

Mitomycin C is a chemotherapy drug that can be placed directly into the bladder.

Immediate Mitomycin C following TURBT

For appropriate patients with suspected low- or intermediate-risk NMIBC, a single postoperative instillation of intravesical chemotherapy may be given soon after TURBT.

Current guidelines recommend that, when used, the immediate instillation should generally occur within 24 hours of TURBT.

Its purpose is to destroy microscopic tumour cells remaining in the bladder and tumour cells released during the resection.

This reduces the risk of recurrence.

When should immediate Mitomycin C be avoided?

It should generally not be administered if there is:

suspected bladder perforation
significant bleeding requiring bladder irrigation
an extensive or very deep resection where perforation is a concern

This is important because chemotherapy leaking outside the bladder can cause significant local tissue injury.

Further courses of intravesical chemotherapy

Selected patients with recurrent or intermediate-risk low-grade NMIBC may receive a course of intravesical chemotherapy rather than simply a single postoperative dose.

The exact drug, schedule and duration depend upon the tumour risk profile and local treatment protocols.

Side effects of intravesical Mitomycin C

Most patients tolerate treatment reasonably well.

Possible side effects include:

urinary frequency
urgency
burning
bladder discomfort
haematuria
chemical cystitis
skin irritation if the medication contacts the genital skin

Rarely, severe bladder inflammation or tissue injury can occur.

Intravesical BCG

BCG stands for Bacillus Calmette-Guérin.

Yes, it originated as a tuberculosis vaccine. In the bladder it performs a completely different job.

BCG stimulates a powerful local immune response against urothelial cancer cells and remains one of the most effective bladder-preserving treatments for high-risk NMIBC.

Who should receive BCG?

BCG is principally considered for patients with:

high-grade Ta tumours
high-grade T1 tumours
carcinoma in situ
other appropriately selected high-risk or intermediate-risk NMIBC

For high-risk NMIBC, full-dose BCG with maintenance treatment for one to three years remains a guideline-supported treatment, while immediate radical cystectomy should also be discussed in appropriate high-risk and particularly very-high-risk disease.

How is BCG given?

BCG is inserted into the bladder through a small catheter.

A typical induction course consists of:

One treatment per week for six weeks.

The solution is retained within the bladder for a prescribed period and then passed out in the urine.

Patients who respond may subsequently receive maintenance BCG.

A commonly used maintenance approach involves three weekly treatments at defined intervals after induction. In high-risk disease, guideline schedules may continue maintenance for up to three years depending upon tumour risk, treatment tolerance and BCG availability.

When should BCG not be given?

BCG is a live attenuated organism and must be administered carefully.

Treatment should generally be postponed in patients with:

visible haematuria
symptomatic urinary tract infection
traumatic catheterisation
very recent TURBT

The EAU lists the first two weeks following TURBT, visible haematuria, traumatic catheterisation and symptomatic urinary infection as absolute contraindications to an intravesical BCG instillation.

Side effects of BCG

A degree of bladder irritation is common.

Patients may experience:

frequency
urgency
burning
bladder discomfort
mild haematuria
fatigue
low-grade fever
flu-like symptoms

These symptoms usually settle.

Rarely, BCG can cause a more significant systemic infection or inflammatory reaction.

Persistent high fever, chills, marked deterioration or severe illness following BCG requires urgent medical assessment.

What if BCG does not work?

Persistent or recurrent high-grade cancer despite adequate BCG treatment requires careful reassessment.

This situation should not simply be managed by repeatedly giving more BCG indefinitely.

Patients meeting criteria for BCG-unresponsive NMIBC should be counselled regarding further treatment, and radical cystectomy remains the oncological standard for suitable patients with BCG-unresponsive high-risk disease. Bladder-preserving alternatives may be considered for patients who are medically unsuitable for cystectomy or decline surgery, ideally within appropriate specialist or clinical-trial pathways.

When should radical cystectomy be considered?

Most patients with superficial bladder cancer will never require removal of their bladder.

However, early radical cystectomy may be discussed for very-high-risk disease, including selected patients with:

aggressive high-grade T1 disease
associated CIS
variant histology
lymphovascular invasion
persistent high-grade disease
BCG-unresponsive disease
other features associated with a high risk of progression

The decision involves balancing the risks of major surgery against the danger of allowing biologically aggressive disease to progress.

Surveillance after treatment

Removing the tumour is only the first chapter.

NMIBC has a significant tendency to recur, and some high-risk tumours can progress. Consequently, regular cystoscopic surveillance is essential.

The first surveillance cystoscopy is generally performed approximately three months after TURBT.

After this, surveillance is tailored to the patient’s risk category.

A practical risk-adapted surveillance framework

Risk group	Typical cystoscopy schedule	Cytology	Upper tract imaging
Low risk	3 months, 12 months, then annually	Usually not routinely required	Not routinely required
Intermediate risk	3 months, then approximately every 6 months for 2 years, then annually	Risk-dependent	Selected patients
High / very high risk	Approximately every 3 months initially, with intervals gradually extended	Usually included	Periodic upper urinary tract imaging

The 2026 EAU guidance continues to recommend that follow-up intensity and duration be determined by the patient’s risk category, with the first cystoscopy at three months.

Individual surveillance schedules may differ depending on pathology, previous recurrences, treatment response, age, comorbidities and the treating urologist’s protocol.

Why is surveillance so important?

A recurrence does not automatically mean that treatment has failed or that the cancer has become life-threatening.

Low-grade papillary tumours may recur while remaining superficial and biologically low risk.

The purpose of surveillance is to identify recurrence early, while it can still be treated appropriately.

High-grade disease requires closer attention because the consequences of missing progression are considerably greater.

Can bladder cancer come back after years?

Yes.

This is why follow-up for intermediate- and particularly high-risk NMIBC can continue for many years.

The frequency of cystoscopy usually decreases when repeated examinations remain clear, but high-risk patients generally require prolonged surveillance.

What can I do after a diagnosis?

One of the most important modifiable factors is:

Stop smoking

Smoking cessation reduces exposure to the carcinogens responsible for many urothelial cancers and provides substantial additional cardiovascular, respiratory and general health benefits.

Patients should also:

attend every scheduled cystoscopy
report recurrent visible haematuria
complete prescribed intravesical treatment
report significant side effects from BCG or chemotherapy
maintain appropriate hydration unless medically restricted
discuss occupational chemical exposure where relevant

The bottom line

Non-muscle-invasive urothelial carcinoma is bladder cancer that has not invaded the muscular wall of the bladder.

The pathway typically involves:

Haematuria or urinary symptoms
↓
Urine tests + imaging
↓
Cystoscopy
↓
TURBT and pathological examination
↓
Stage + grade + risk classification
↓
Risk-adapted treatment

For some patients, TURBT followed by surveillance may be sufficient.

Others benefit from intravesical Mitomycin C or another intravesical chemotherapy to reduce recurrence.

Patients with high-grade disease, T1 cancer or CIS frequently require intravesical BCG, usually incorporating induction and maintenance treatment.

Very-high-risk or BCG-unresponsive disease may require consideration of radical cystectomy.

Most importantly, bladder cancer treatment does not finish when the initial tumour has been removed. Long-term cystoscopic surveillance is an integral part of treatment.

A final word

Bladder cancer can be a persistent visitor, but surveillance means we do not leave the front door unattended.

Early detection, complete TURBT, accurate pathological staging, appropriate intravesical therapy and structured follow-up provide the best opportunity to keep non-muscle-invasive bladder cancer under control.

This information is intended as general patient education and does not replace individual assessment or treatment advice from your urologist. Management should be tailored to the pathology, tumour risk category, general health and individual circumstances of each patient.

Living with an indwelling urethral catheter

November 23, 2025/0 Comments/in Bladder Surgery, Blog Post, Prostate Surgery, Urethral Surgery/by drjo

An indwelling urethral catheter is a soft tube passed through the urethra into the bladder. A small balloon holds it in place and urine drains into a bag. It may be needed for a few days after an operation or for longer when the bladder cannot empty safely. The reason for the catheter and a plan for review should be clear to the patient and the people helping with their care.[1, 2]

Why might a catheter be needed?

Common reasons include acute urinary retention, an obstruction to urine flow, temporary drainage after surgery, and selected cases of chronic retention when other options are unsuitable. In hospital, a catheter may be used to monitor urine output in a critically ill person or manage bleeding and clots. It can occasionally support comfort at the end of life. A urethral catheter is generally not the first response to urinary leakage alone.[1]

When practical, the team should discuss whether the catheter can be removed after a trial of void, whether intermittent self-catheterisation is possible, or whether a suprapubic catheter may be more suitable for longer-term drainage. The best choice depends on bladder function, dexterity, the underlying condition and the person’s wishes.[1, 3]

What might it feel like, and what can go wrong?

Some people notice discomfort or a sense of needing to pass urine after insertion. Bladder spasms can cause cramping or urine to leak around the tube. Leakage can also mean that the catheter is kinked or blocked, so it should be checked rather than simply treated as incontinence. Other possible problems include blood in the urine after insertion or a change, skin irritation, accidental pulling or displacement, blockage from debris or encrustation, and infection.[2, 3]

A long-term urethral catheter can also cause pressure or trauma at the urethral opening; persistent soreness or a change in its appearance deserves review. Bladder stones and repeated blockages are further reasons to reassess the drainage plan. The longer a catheter remains, the more opportunity there is for bacteria to colonise it, so it should stay in place only while needed.[3, 4]

How often should a long-term catheter be changed?

There is no single safe change interval for every catheter and every patient. The plan depends on the catheter material and manufacturer’s instructions, local nursing policy, comfort, drainage, and whether it repeatedly blocks or becomes encrusted. Some community protocols plan changes approximately every four to eight weeks, but an individual plan may differ. The interval should not exceed the relevant product’s recommended duration.[1, 3]

Changing a catheter more frequently just to prevent infection has not been shown to help. A catheter may instead need an earlier change if it is blocked, damaged, displaced, causing problems, or as part of managing a symptomatic infection. People with a history of difficult insertion, urethral injury or bleeding should have a specific plan for who can safely perform the change.[1, 3]

At each review, it is worth asking: Is the catheter still necessary? Could a trial without it or another drainage method be considered?[1]

Day-to-day care at home

Keep the drainage bag below bladder level, avoid kinks in the tubing, and secure the catheter so it does not pull. Wash your hands before and after handling the bag. Follow the nurse’s instructions for emptying it and for cleaning the area where the catheter enters the body. Ordinary hygiene is usually enough; do not disconnect the closed drainage system, flush the catheter or take preventive antibiotics unless your treating team has given a specific instruction.[3, 5]

Drink according to your usual health advice. If you have a fluid restriction for heart or kidney disease, follow that plan rather than trying to drink extra to “flush” the catheter. Ask your nurse which supplies to keep at home and whom to call after hours if drainage stops.[2]

Bacteria in urine: when are antibiotics needed?

With a catheter in place, bacteria commonly grow on the catheter surface. After a month, bacteriuria is found in nearly everyone with a long-term catheter. A positive urine culture without symptoms usually reflects colonisation, not an infection requiring antibiotics. Routine screening or treatment of asymptomatic bacteriuria is generally discouraged because antibiotics can cause side effects and encourage resistant bacteria. Exceptions include pregnancy and certain invasive urological procedures, where the treating team will advise on testing and treatment.[4, 6]

Seek clinical assessment for possible infection if you develop fever, rigors, new pelvic or flank pain, feel distinctly unwell, or have other new symptoms that could indicate infection. In a frail person, a new change in function or confusion warrants assessment of several possible causes rather than automatically assuming a UTI. Cloudy or strong-smelling urine, sediment, or a positive dipstick on its own does not usually justify antibiotics.[4, 6, 7]

When a symptomatic catheter-associated UTI is suspected, a clinician should assess you and arrange a properly collected urine specimen if indicated—not from the drainage bag. Treatment is chosen in light of symptoms, culture results, allergies and local guidance. If the catheter has been in place for more than two weeks and still needs to remain, changing it as part of treatment is commonly recommended. Routine antibiotics at every scheduled catheter change are not recommended.[7, 8]

When to get help promptly

Contact your nurse or doctor promptly if urine stops draining, the catheter falls out, you have significant pain or new bleeding, or urine is leaking around the catheter with little in the bag. Check for a kink or a full bag, but do not forcefully flush or reinsert a catheter yourself unless specifically trained and instructed. Seek urgent medical care if drainage has stopped and you have a painful or swollen lower abdomen, or if you have fever, shaking chills or feel seriously unwell.[2]

Catheter support in Bundaberg

Some people can have catheter assessment and planned changes at home through a community nursing service. Ozcare and BlueCare provide home nursing in the Bundaberg area; whether a nurse can provide catheter care for an individual depends on referral, staffing, clinical needs, service area and funding arrangements. Ask the provider directly about availability and costs before relying on a visit.[9, 10]

For my Bundaberg patients, Sandra Ilett, a continence nurse with Community Nurse Service, is another local contact for bladder and catheter-related care. Sandra and her colleague Carla Kerr have also seen patients at the nurse-led clinic at The Friendlies Medical Suites. Patients can discuss a suitable referral and whether a home visit or clinic appointment is available. Community Nurse Service: (07) 4126 2002.[11] This mention recognises local nursing support; it is not a claim that one service is preferable for every patient.

A written catheter plan should record the reason for drainage, catheter details, the planned review or change, who will provide care, and whom to call if problems arise. Community nurses, the GP and urology team can then coordinate care across visits.

This article provides general information. Follow your individual catheter plan and seek clinical advice for new symptoms or a catheter that is not draining.

References

Ileal Conduit / Urinary Diversion

November 6, 2025/0 Comments/in Bladder Surgery/by drjo

Indications:

Cystectomy for cancer
Irradiated bladder with hemorrhagic cystitis that is not managed well with endoscopic procedures
Neurogenic bladders with vesical-ureteric reflux
Chronic bladder pain

This procedure is not performed by me, and you will be referred to a Urologist who does.

Robotic Assisted Radical Cysto-prostatectomy with Ileal Conduit or Neobladder

November 6, 2025/0 Comments/in Bladder Surgery/by drjo

Indications in men:

Muscle invasive urothelial cancer
Squamous carcinoma bladder
Adenocarcinoma bladder

I don’t perform this operation, and you will be referred to a high-volume surgeon in a larger institution.

Robotic Assisted Radical Cystectomy with Ileal Conduit / Neobladder

November 6, 2025/0 Comments/in Bladder Surgery/by drjo

Indications:

Muscle invasive urothelial cancer
Squamous carcinoma bladder
Adenocarcinoma bladder

I don’t perform this operation, and you will be referred to a high-volume surgeon in a larger institution.

Flexible Cystoscopy with Urethral Dilatation

November 4, 2025/0 Comments/in Bladder Surgery, Urethral Surgery/by drjo

A diagnostic day procedure under local anesthetic, where a flexible cystoscope is placed in the bladder via the urethra

Why is it done?

To investigate:

Hematuria (blood in the urine)
Recurrent urinary tract infections
Space occupying lesions in the kidneys, ureters, bladder and urethra
Abnormal cells suggestive of urothelial carcinoma, on urine cytology
Possible urethral stricture

How is it done?

A cystoscopy is performed by placing a camera in the urethra with the help of a lubricant jelly and saline
If a narrowing is found, a guidewire will be placed and urethra dilated
The bladder is then distended using the fluid
The inside of the bladder is viewed for pathology.
If any suspicious lesions are seen, a biopsy will be taken.
Urine would have been sent for cytology prior to the procedure, to rule out the existence of cancer.
Antibiotics may be given to prevent infection

What to expect after the procedure?

An indwelling catheter will be placed for 3 days
Bladder infection ranging from a burning sensation to, fever, to puss (rare)
Blood stained urine
Lower abdominal discomfort which will persist for a few days
NB! Each person is unique and for this reason symptoms vary.

What next?

This all depends on what is found during the procedure. All the options will be discussed in detail.
With the removal of stents, the ureters have been dilated and will regain function (peristalsis) as soon as the stents are out. Thus slight pain can be expected in the first 24-48hrs.
Urethral strictures with an IDC will require a trial of void 3 days later
There may be some blood in the urine. This can be remedied by drinking plenty of fluids until it clears.

Urethral Dilatation

If you have a urethral stricture, a guidewire will be placed and the narrowing dilated
There may be some hemorrhaging and you may need a catheter for 3 days
This will be removed at the hospital in 3 days or alternatively arrange for your GP to remove.
I will review in 6 –8 weeks

Wes Flexible Cystoscopy and Urethral Dilatation IDC

Augmentation Bladder – Ileocystoplasty

November 13, 2019/0 Comments/in Bladder Surgery, Incontinence Surgery/by agileadmin

Bladder Diverticulectomy – Robotic-assited

November 13, 2019/0 Comments/in Bladder Surgery/by agileadmin

Open excision of bladder diverticulum. Controversial procedure for the excision of a bladder diverticulum where there is bladder calculus and bladder function is compromised/

Why is it done?

This procedure is performed when all other treatment options are exhausted with recurrent symptoms.
Symptoms include: a weak stream, nightly urination, frequent urination, inability to urinate, sudden cut-off of stream, (LUTS), recurrent bladder infections, recurrent bladder calculi (stones).
Medication such as Flomaxtra, Urorec or Minipress etc. should always be given as a first resort.
Step-up therapy should have been used for prostates larger than 35-50cc with either Duodart, Avodart or Proscar and can be used as a first line in these huge prostates.
A TURP may have been performed to dis-obstruct a huge prostate.
Neurogenic causes of bladder dysfunction should be excluded by means of a Urodynamic study.
Patient informed decision is vital.
It provides a quicker solution with more marked side-effects and risks.

How is it done?

Patients will receive a general anaesthesia, unless contra-indicated.
Prophylactic anti-biotics is given.
An indwelling catheter is placed, and the bladder is filled with saline.
Robotic access with 6 port placements.
The retropubic space of Retzuis is entered.
The bladder is opened anteriorly in the midline.

A Foleys catheter is placed in the diverticulum.
The bladder incision is extended to the diverticulum. Diverticulum is excised.
Special care is required for diverticula close to the ureters. Placement of ureteric catheters are done to prevent ureteric injury.
Bladder is closed in 2 layers over a 3-way irrigation catheter.
A drain is left for a couple of days.
You may have continuous Antibiotics over the next few days.

What next?

You will spend 2-3 nights in hospital.
You will have a catheter for 14 days.
A drain for 1 -2 days.
You will be discharged as soon as you are drain free, temperature free and have opened your bowels.
You may initially suffer from urge symptoms caused by the catheter.
There may be some blood in your urine. You can remedy this by drinking plenty of fluids until it clears.
A ward prescription will be issued on your discharge, for your own collection at any pharmacy.
A follow-up appointment will be scheduled for 2 weeks for a cystogram.
Should the cystogram confirm to urine leaks, your catheter will be removed.
A review appointment is scheduled 6 weeks later.
Don’t hesitate to ask Jo if you have any queries.
DON’T SUFFER IN SILENCE, OR YOU WILL SUFFER ALONE!

Side–effects

Rarely blood loss requiring blood transfusion.
Infection.
Prolonged hospital stays.
Urine leak requiring prolonged catheterization.
NB! Each person is unique and for this reason symptoms vary!

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Wes Bladder Diverticulectomy