Urinary bladder carcinoma is a common type of cancer, the incidence of which has been increasing in Germany in recent years. The tumour originates from the bladder mucosa, the so-called urothelium. A distinction is made between tumours that tend to grow in the upper layers of the mucous membrane (non-muscle-invasive) and those that grow into the muscle layer (muscle-invasive) of the bladder or beyond (then usually extending beyond the organ). In some cases, other areas of the urinary tract (e.g. renal pelvis, ureter or urethra) may also be affected.
The Department of Urology at Ulm University Hospital treats over 400 patients with bladder cancer every year and the entire treatment team, both doctors and nursing staff, specialise in this disease. In 2017, the clinic was certified by the German Cancer Society as an oncology centre with a focus on the urinary bladder, as the high quality requirements for the treatment of affected patients are met. We are happy to provide you with advice and further treatment planning.
We treat bladder cancer in accordance with the latest scientific findings and guidelines. We will be happy to provide you with advice and further treatment planning during our consultation hours if you have been diagnosed with a bladder tumour. Second opinion consultations are also possible. Comprehensive diagnostics, including photodynamic procedures with hexaminolevulinic acid (PDD) and high-resolution imaging procedures, are used. Endoscopic (transurethral) surgery, minimally invasive surgery, all open surgical procedures (radical removal of the bladder) and all forms of incontinent and continent urinary diversion (ureterocutaenosomy, ileum conduit, neobladder, pouch) are part of our treatment spectrum. If you have more advanced bladder cancer, we offer the entire spectrum of modern drug-based tumour therapy, including clinical trial programmes with innovative drugs. This also includes the latest forms of immunotherapy. We maintain close interdisciplinary collaboration with our cooperation partners in the interdisciplinary tumour board of the Tumour Centre (Comprehensive Cancer Centre Ulm; CCCU).
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A common first symptom of patients with bladder carcinoma is an admixture of blood in the urine that is not painful (so-called "painless macrohaematuria"). Repeated bladder infections or an increased and unpleasant urge to urinate can also be typical symptoms.
If a bladder tumour is suspected, an ultrasound examination and cystoscopy are performed first. If the suspicion is confirmed, the tumour is removed by means of an endoscopic procedure (so-called "transurethral resection of the bladder tumour"; TUR-B). The final diagnosis and exact staging of the tumour is determined by a microscopic histological examination of the tissue by a pathologist. The further treatment recommendation depends on this.
Photodynamic diagnosis (PDD) of bladder cancer
Tumours of the bladder are sometimes not clearly distinguishable visually from the normal bladder mucosa and are therefore difficult to detect using conventional cystoscopy.
In PDD, a special substance (hexaminolevulinic acid) is introduced into the bladder via a thin catheter shortly before the operation. This is increasingly absorbed by tumour cells. By illuminating the tumour areas with blue light, they can then appear reddish-pink during the operation and thus be better recognised.
International studies have shown that PDD can be used to better diagnose flat tumours in particular that grow in the mucous membrane and tend to be more aggressive (e.g. carcinoma in situ; CIS) and that the recurrence of tumours (known as the "recurrence rate") can be reduced as a result of more complete removal.
Based on these findings, PDD is frequently used at our clinic. Whether the use of this method makes sense in your individual situation is decided by the operating doctor.
Endoscopic transurethral surgical procedures
During endoscopic surgery, the bladder mucosa is assessed using a cystoscope. The same procedure can be used to remove bladder tumours during "TUR-B" (see above). This minimally invasive procedure is used in particular for the diagnosis and treatment of non-muscle-invasive bladder tumours. All transurethral resection techniques are offered at our clinic.
Open surgical procedures
Muscle-invasive bladder carcinomas or extensive non-muscle-invasive tumours can usually only be treated by complete removal of the bladder ("radical cystectomy") and any affected lymph nodes. A high level of expertise in this field has been achieved at our clinic through decades of experience and the high number of operations. We are particularly experienced in continent bladder replacement using the so-called neobladder, which is constructed from small intestine. The corresponding surgical technique for creating an "ileum neobladder" was developed and established in the Department of Urology at Ulm University Hospital by Professor Hautmann. The technique has since become established worldwide and is now the standard procedure in many clinics.
In addition to the neobladder, we offer all forms of continent and incontinent urinary diversion for both men and women. We will be happy to provide you with detailed information and advice before a necessary operation in order to determine together which form of urinary diversion is the most favourable for you.
Care
In addition to the surgeon's experience, the entire team providing care and in particular the nursing care after the operation play a decisive role in the optimal success of an operation. The removal of the urinary bladder with the creation of a continent replacement bladder or an artificial urinary outlet (so-called "uro-stoma") represents a new life situation for the affected patients, in which comprehensive care is crucial. The nursing staff at our clinic have many years of experience in caring for patients after bladder removal. Continuous further development of the care concepts ensures optimum patient care. This also includes so-called stoma therapy, through which patients who are not suitable for a neobladder are instructed in several sessions on how to deal well with their urostoma and achieve the best possible quality of life.
Drug-based tumour therapy
Drug-based treatment of bladder cancer plays an important role, particularly in advanced tumour stages. Our team of doctors has extensive experience with chemotherapy and immunotherapy for bladder cancer, both in their implementation and in the prevention and treatment of possible therapy-related side effects. In addition to guideline-compliant patient care, we would also like to give our patients access to innovative therapies that are offered at our clinic as part of clinical trials. This can be examined and discussed in an individual, detailed consultation with a doctor. If you are taking part in a clinical trial, care and monitoring will be provided by our trial centre with the involvement of your treating urologist in private practice.
The exact cause of the development of bladder cancer is not yet known. Nevertheless, it is known that risk factors favour the development of bladder cancer. Tobacco smoking is one of the main risk factors for bladder cancer. Occupational risk factors from cancer-causing substances such as paints, tar, dyes and solvents can also play a role. In very rare cases, a genetic cause and a familial occurrence can be observed.
Preventive screening along the lines of mammography for the detection of breast cancer or colonoscopy for the earliest possible detection of colon cancer is not recommended for bladder cancer, as the probability of detecting a tumour is significantly lower. If symptoms occur (blood in the urine, repeated bladder infections or an increased and unpleasant urge to urinate without a clearly identifiable cause), a doctor should be consulted for further planning. Even if in many cases the cause of the symptoms turns out to be relatively harmless, a bladder carcinoma must usually still be ruled out.
Endoscopic removal of the tumour is almost always necessary. If the tumour is detected early and is limited to the upper layers of the bladder mucosa, the bladder can often be preserved. Complete surgical removal of the bladder and thus of the bladder carcinoma is the best way to achieve a permanent cure in more aggressive forms of the disease. Alternatively, radio-chemotherapy can be used if surgical removal of the bladder is not possible or is rejected by the patient.
Participating clinics & co-operation partners
For comprehensive interdisciplinary care and treatment, we work together with various specialist disciplines at the university hospital (radiology, nuclear medicine, surgery, oncology, radiotherapy, pathology, pain outpatient clinic) and external cooperation partners as required. Experienced therapists and counsellors from various fields are also available to you during your inpatient stay (e.g. psychologists, social counselling service and physiotherapists).
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