Bladder neoplasms, identified through cystoscopy or imaging techniques such as ultrasound or CT scan, are subjected to transurethral resection (TURB). This non-invasive and painless procedure serves a dual purpose: both diagnostic and therapeutic. Through TURB, it is indeed possible to definitively remove the more superficial lesions and characterize them through histological examination. The procedure is generally performed under spinal anesthesia, in a gynecological position, and has a variable duration depending on the number and extent of the lesions.

In cases of lesions infiltrating the muscular wall of the bladder, unfortunately, TURB is used just for staging purposes, without curative intent. Patients with tumors infiltrating the muscular wall of the bladder must, unfortunately, undergo cystectomy.

There are two types of cystectomy: 

• Radical cystectomy: this involves the complete removal of the bladder along with various adjacent pelvic organs. In men, this procedure also includes the removal of the prostate, seminal vesicles, and vas deferens, while in women, it involves the removal of the uterus, uterine annexes, and the anterior wall of the vagina. The complete removal of the organ necessitates the creation of urinary diversions. The alternatives include orthotopic neobladder, ureterocutaneous anastomosis, or ureteroileocutaneous anastomosis.
• Partial cystectomy: this involves the partial removal of the bladder.

The two procedures are not interchangeable: it is the surgeon who chooses the best and safest approach, taking into account the patient’s health status and the characteristics of the disease.

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