A diagnosis of bladder cancer is frightening, and what happens next matters enormously. The quality of your initial evaluation, the completeness of your surgical resection, and the appropriateness of your follow up treatment all have a direct impact on your long term outcome. At Urology Associates of Green Bay, we provide comprehensive bladder cancer care from the first cystoscopy through surveillance, intravesical therapy, and when necessary, robotic cystectomy with urinary reconstruction.
Our goal is always to spare the bladder when it is safe to do so. When bladder removal is necessary, we offer that surgery locally with experienced robotic surgeons, so you do not have to travel hours to an academic medical center to receive expert care. We work as part of a multidisciplinary team with medical oncology and radiation oncology to ensure every treatment decision is informed, coordinated, and in your best interest.
Blood in your urine? Do not ignore it. Call (920) 433-9400 (De Pere) or (715) 732-3420 (Marinette) for a prompt evaluation.
How Bladder Cancer Is Found
Bladder cancer is most commonly discovered during an evaluation for hematuria, or blood in the urine. Sometimes the blood is visible, turning the urine pink, red, or cola colored. Other times it is detected only on a urine test during a routine exam or evaluation for other symptoms. Blood in the urine always warrants a thorough evaluation, because while there are many benign causes, bladder cancer must be ruled out.
The standard workup includes a CT scan of the abdomen and pelvis (CT urogram) to evaluate the kidneys, ureters, and bladder for masses, stones, or other abnormalities. This is followed by cystoscopy, a direct look inside the bladder using a small flexible camera passed through the urethra. Cystoscopy is performed in our office and is well tolerated. At Urology Associates, we use narrow band imaging (NBI) technology during cystoscopy, which uses specific wavelengths of light to enhance the visibility of blood vessels and mucosal patterns on the bladder wall. This helps us detect tumors, including flat or subtle lesions that might be missed under standard white light.
Surgical Treatment: Transurethral Resection of Bladder Tumor (TURBT)
If a tumor is identified, the next step is a transurethral resection of bladder tumor, or TURBT. This procedure removes the visible tumor from the bladder wall and provides tissue for pathology to determine the type, grade, and stage of the cancer. The pathology results are critical because they determine everything that comes next: whether additional treatment is needed, what type, and how aggressively the cancer should be managed.
Larger tumors or those requiring more extensive resection are treated in the operating room under anesthesia at Emplify Health in Green Bay. In many cases, a single dose of gemcitabine is instilled into the bladder immediately after tumor resection. This post operative intravesical chemotherapy has been shown to reduce the risk of early recurrence and is now a standard part of care for appropriate patients.
Preventing Recurrence: BCG and Newer Intravesical Therapies
Bladder cancer has a well known tendency to recur, which is why ongoing treatment and surveillance are so important. For intermediate and high risk non muscle invasive bladder cancer, intravesical immunotherapy is the standard of care to reduce the risk of the cancer coming back or progressing to a more advanced stage.
BCG (Bacillus Calmette Guerin) is the cornerstone of intravesical immunotherapy. It is a live bacterial preparation instilled directly into the bladder through a catheter, where it stimulates the immune system to attack residual cancer cells on the bladder wall. BCG treatment is administered as a series of weekly instillations followed by periodic maintenance treatments over one to three years. For the right patients, BCG significantly reduces the risk of recurrence and progression and is one of the most important treatments in bladder cancer management.
For patients whose cancer recurs despite adequate BCG therapy, a situation known as BCG unresponsive disease, we offer newer treatment options that can allow many patients to keep their bladder. Anktiva (nogapendekin alfa inbakicept) is an intravesical immunotherapy used in combination with BCG for BCG unresponsive carcinoma in situ. Adstiladrin (nadofaragene firadenovec) is a gene therapy delivered into the bladder that causes bladder cells to produce an immune stimulating protein. Pembrolizumab (Keytruda) is a systemic immunotherapy that can be used for BCG unresponsive disease and is typically managed in our office, though in some cases we coordinate with medical oncology. These newer therapies represent a significant advance for patients who previously had few options short of bladder removal.
Surveillance: Staying Ahead of Recurrence
Because of bladder cancer’s tendency to recur, long term surveillance is a critical part of your care. After initial treatment, we perform regular cystoscopy at defined intervals to monitor the bladder for any signs of recurrence. The frequency of surveillance depends on the grade and stage of your original cancer, and we follow established guidelines to ensure nothing is missed. Our use of narrow band imaging during surveillance cystoscopy gives us an additional tool to detect recurrences as early as possible, when they are most treatable.
Advanced Disease: Robotic Cystectomy and Urinary Reconstruction
When bladder cancer has invaded the muscle wall (muscle invasive bladder cancer) or when high risk non muscle invasive cancer cannot be controlled with bladder sparing treatments, radical cystectomy (complete removal of the bladder) is the recommended treatment. This is a major surgery, and the experience of your surgical team matters.
At Urology Associates, Dr. Mian and Dr. McAdams are highly experienced in robotic radical cystectomy, a minimally invasive approach that uses the da Vinci robotic surgical system to perform the operation through small incisions. Compared to traditional open surgery, the robotic approach typically results in less blood loss, less pain, shorter hospital stays, and faster recovery. We perform these procedures locally at Emplify Health in Green Bay, which means you do not need to travel several hours to a major academic center to receive this level of care.
When the bladder is removed, a new pathway for urine must be created. This is called urinary diversion, and we offer two primary options. An ileal conduit uses a short segment of small intestine to create a channel that carries urine from the ureters to an opening (stoma) on the abdomen, where it drains into an external collection bag. This is the most common form of diversion and is reliable, durable, and well tolerated. A neobladder uses a longer segment of intestine to construct a new internal reservoir that is connected directly to the urethra, allowing you to urinate in a more natural way without an external bag. The neobladder option is available for both men and women and can be an excellent choice for motivated patients who are good surgical candidates.
The decision between ileal conduit and neobladder depends on your anatomy, the extent of your cancer, your overall health, your dexterity and motivation, and your personal preference. We discuss both options in detail before surgery so you can make an informed choice.
Multidisciplinary Care: Working Together
Bladder cancer, particularly muscle invasive disease, is best managed by a team. We work closely with medical oncology before and after cystectomy to determine whether chemotherapy or immunotherapy should be part of your treatment plan. Neoadjuvant chemotherapy (given before surgery) has been shown to improve survival in muscle invasive bladder cancer and is part of the standard of care for appropriate patients. Adjuvant therapy (after surgery) may also be recommended depending on the final pathology. In select cases, we coordinate with radiation oncology as part of a bladder sparing protocol or for palliation of advanced disease.
Frequently Asked Questions
How is bladder cancer found?
Bladder cancer is most often found during an evaluation for blood in the urine (hematuria). The standard workup includes a CT urogram and a cystoscopy, a direct look inside the bladder with a small camera. At Urology Associates, we use narrow band imaging during cystoscopy to improve our ability to detect subtle tumors.
What if BCG does not work?
For patients whose cancer recurs despite BCG treatment (called BCG unresponsive disease), we offer newer therapies including Anktiva (N-803), Adstiladrin (a gene therapy), and pembrolizumab (Keytruda). These options allow many patients to keep their bladder even when BCG has failed. The specific recommendation depends on the characteristics of your tumor and your overall health.
What is a radical cystectomy?
A radical cystectomy is the surgical removal of the entire bladder. It is recommended for muscle invasive bladder cancer or for high risk non muscle invasive cancers that cannot be controlled with bladder sparing treatments. At Urology Associates, Dr. Mian and Dr. McAdams perform robotic cystectomy, which is a minimally invasive approach that offers faster recovery and fewer complications than open surgery.
Do I have to travel to a major medical center for cystectomy?
No. Dr. Mian and Dr. McAdams are highly experienced in robotic cystectomy and perform these procedures locally at Emplify Health in Green Bay. You do not need to travel several hours to an academic medical center to receive expert surgical care. We also coordinate closely with medical oncology and radiation oncology to ensure your treatment plan is comprehensive.
What are the options for urinary diversion after bladder removal?
When the bladder is removed, a new pathway for urine must be created. We offer two main options. An ileal conduit uses a short segment of intestine to create a channel that drains urine into an external collection bag worn on the abdomen. A neobladder uses a longer segment of intestine to construct a new internal reservoir that connects to the urethra, allowing you to urinate in a more natural way without an external bag. Both options are available for men and women. The best choice depends on your anatomy, cancer characteristics, overall health, and personal preference.
Do you see patients from outside the Green Bay area?
Yes. We see patients from across northeastern Wisconsin and the Upper Peninsula of Michigan. Call our De Pere office at (920) 433-9400 or our Marinette office at (715) 732-3420.
Don’t Wait on Symptoms
If you have blood in your urine, do not ignore it. Early detection gives you the best chance at successful, bladder sparing treatment. And if you have been diagnosed with bladder cancer and want to explore your options or get a second opinion, we are here. Call our De Pere office at (920) 433-9400 or our Marinette office at (715) 732-3420.
Urology Associates of Green Bay. Comprehensive bladder cancer care, from diagnosis through advanced robotic surgery, right here in northeastern Wisconsin.