Bladder · Diagnostics
Diagnosis and treatment planning
One question decides everything that follows: Has the tumour reached the muscle layer of the bladder wall?
How it makes itself known
Blood in the urine (haematuria)
The most common first sign — and usually painless. That is exactly why it is often watched for too long. Even a single episode of blood that has disappeared again should be investigated.
Irritative symptoms
A frequent urge to urinate, burning, or the feeling of not emptying the bladder — especially when a suspected bladder infection does not respond to antibiotics.
Risk factors
Smoking is the most important one. Added to this are occupational exposures to aromatic amines, for instance in paint, varnish, rubber and leather processing.
The TURBT
Transurethral resection of a bladder tumour (TURBT) is diagnosis and treatment in a single step. An instrument about the thickness of a pen is passed into the bladder through the urethra — with no external incision. The visible tumour is removed and examined histologically.
What matters is that muscle tissue from the base of the tumour is obtained as well. Only then can it be answered whether the tumour has reached the muscle layer — and the entire further treatment depends on that.
Blue-light cystoscopy
Some tumours grow flat and are barely visible under ordinary white light. In photodynamic diagnosis, a solution is instilled into the bladder before the procedure that accumulates preferentially in tumour cells. Under blue light, these areas glow red.
This makes lesions visible that would otherwise be missed — especially flat carcinoma in situ. The benefit lies in more complete removal at the first procedure.
The decision point
Without involvement of the muscle layer, the bladder can as a rule be preserved. Treatment is carried out through the urethra, often supplemented by a therapy instilled directly into the bladder; regular check-ups follow.
With involvement of the muscle layer, complete removal of the bladder is the established approach with curative intent. What that means in practice is described on the page on robot-assisted radical cystectomy.
Chemotherapy before the operation
If the tumour has reached the muscle layer, platinum-based chemotherapy is usually recommended before the operation — provided you are fit for it. It shrinks the tumour before surgery and improves the outlook compared with surgery alone. Current treatment regimens increasingly combine it with immunotherapy. Whether and in what form this is an option for you is something we decide together in the tumour board.
Second opinion
Newly diagnosed with bladder cancer? Before the treatment decision, a second look is worthwhile.
Sources
Lenis AT, Lec PM, Chamie K, et al. Bladder Cancer: A Review. JAMA 2020;324(19):1980–1991.
Kamat AM, Hahn NM, Efstathiou JA, et al. Bladder cancer. Lancet 2016;388(10061):2796–2810.
Maisch P, Hamidi Madani M, Koziarz A, et al. Blue versus white light for transurethral resection of non-muscle invasive bladder cancer. Cochrane Database Syst Rev 2026.
Bladder Cancer. National Comprehensive Cancer Network, Stand 2026-06-22.
How treatment proceeds is decided by the department together — not by one person alone.
Contact
A second opinion before the treatment decision
Bring the TURBT report, the histological findings and any cross-sectional imaging you have. We will put them into context together.
Consultation hours
- Wednesday · 14:00
- Thursday · 08:30–16:00
PD Dr. med. Sami-Ramzi Leyh-Bannurah. Appointments are arranged by the urology secretariat.