Most bladder cancers are diagnosed following the symptom of haematuria (blood in the urine). Many bladder cancers nowadays are a result of smoking. 80 % of bladder cancers are in the superficial lining of the bladder at diagnosis, and are treated with telescopic resection (cystoscopy and resection) in hospital. Subsequent regular inspections with cystoscopy are mandatory to prevent and treat any local recurrences and to prevent progressive or invasive disease.
Some patients with more aggressive superficial cancer disease will be advised to also undergo bladder immunotherapy with six, weekly bladder washes of BCG through a catheter, again to reduce their future risks.
The 20% of patients with more invasive cancers at diagnosis, and those others whose disease recurs or progresses to "muscle invasive " disease, will be counselled regarding more aggressive treatments. These may include radical surgery to remove the bladder and prostate (cystectomy). Following this major but effective operation the urinary stream is diverted either to a bag on the skin (ileal conduit), or a "new bladder" (ileal neobladder) is constructed from a bowel segment and connected to the urethra again for the purposes of voiding. Each has advantages and disadvantages which will be discussed to allow the best decision. A less common, and slightly less effective option, to spare the bladder is the combination chemotherapy and radiotherapy.
Sexual function is often impaired following such radical surgery. In the male patient, nerve preserving surgery may allow some recovery of erectile function usually with the aid of oral agents like Viagra or Cialis, or penile injections of Caverject / Trimix. Failing that, penile prosthesis surgery is quite successful.
If a patient has distant or metastatic disease, such as in the regional lymph nodes, then adjunctive or salvage chemotherapy is an option, depending on the patient's medical condition and prognosis. This systemic treatment may prolong life, but is not in itself curative.