The best bladder cancer surgery in Delhi, performed at Delhi Urology Hospital is determined after diagnosing the symptoms. The tumors are suspected when patient presents with following symptoms:

• Passage of blood or blood clots in urine (i.e. hematuria).
• Hematuria with painful retention of urine due to clots.
• Painful urination. 
• Irritative urinary symptoms such as frequency urgency, urge incontinence, nocturia.
• Pain in lower back. 
• Loss of weight and appetite (in advanced) bladder cancer cases.

Based on the signs and symptoms, your urologist will order a few tests to diagnose bladder tumors:

• Urine routine microscopy and culture. This is to see the presence of RBCs (red blood cells) in urine as well as to rule out infection.
• Urine cytology is done three days in a row with first morning urine sample to look for malignant career cells in urine.
• Ultrasound. This tells us the size of the tumor and provides information about the kidneys, ureters and prostate.
• Contrast Enhanced CT scan (CECT). This is the investigation of choice for diagnosing bladder tumors and also aids in planning of surgery of the patient.
• PET scan. This is done in advanced cases to see whether the tumor is limited to bladder or has spread outside it to involve other parts of the body.

• Complete blood tests, chest x-ray, ECG and if needed echocardiography (ECHO) are done to assess the patient’s fitness for surgery.
• Pre-operative anesthesia check up by the anesthesiologist is done to assess the patient.
• Blood sugar and blood pressure are optimized in cases of diabetic and hypertensive patients.
• Patients are instructed to be fasting overnight and are admitted on the day of the surgery.

• This bladder cancer surgery in Delhi is done preferably under general anesthesia i.e. patients are put to sleep before the surgery and are woken up after the procedure is over. In case of small tumors, it can be done under spinal anesthesia also by giving a small injection in the back which numbs and immobilizes the body below the umbilicus.
• Patients are placed in a lithotomy position and using a telescope, a thin tube called resectoscope which has a loop of wire at its end, through which current runs, is introduced into the bladder.
• The entire bladder is inspected and the small tumors are completely cut out (resected out) and sent for biopsy. After the removal of the tumor a part of normal bladder wall just below the tumor is also resected and sent for biopsy to judge how deep the tumor was. In cases of very large tumors either a small tissue is sent for biopsy or the surgery is done in stages.
• In case of small tumors, at the end of procedure, intravesical chemotherapy is given to take care of any microscopic cancer cells not removed by surgery.
• At the end of the procedure a catheter is placed inside the bladder to help irritate the blood and/or clots out of the bladder and to help drain it belter.

• Patients stay in the hospital for 1-2 days during which their bladder is continuously irrigated to prevent any bleeding or clotting in the bladder post-surgery.
• Intravenous antibiotics and painkillers are given to prevent infections and to provide pain relief.
• Patients are generally given soft diet during hospital stay.
• Patients are discharged with the catheter after satisfactory post-operative recovery.

Patients are generally called back to the hospital 4-5 days post-surgery for removal of catheter. By this time generally the biopsy report is ready. Depending on the biopsy report further treatment is planned as follows:

• Low grade non-muscle invasive disease

In these cases, patient is advised for a regular follow up as bladder tumors tend to re-occur. They are advised to repeat an ultrasound every 3 months. Also a cystoscopic examination of the bladder is done every 3 months for first 2 years; every 6 months for the next 2 years and then once a year for another 2 years.

• High grade non-muscle invasive disease

In these cases patients are given weekly intravesical chemotherapy/immunotherapy for preventing recurrence of disease. The follow up protocol is same as that of low-grade disease.

• High grade muscle invasive disease

In such cases, the bladder tumor has gone out of the bladder and they are not candidates for further endoscopic management. In such cases the following treatments are considered.

In cases where the tumor has invaded the bladder wall but is a single and not a very large tumor, then that portion of the bladder along with an adequate margin is removed and the rest of the bladder is repaired with stitches. This is done in carefully selected cases as bladder tumors generally are multifocal. Patients have to stay in the hospital for 2-3 days post-surgery and the urinary catheter is kept for 3 weeks.

Cost of partial cystectomy in Delhi at Delhi Urology Hospital starts from Rs. 1,50,000

In case of very large tumors or tumors in multiple places a radical cystectomy is done. In this surgery, the entire bladder and the draining lymph nodes are removed and sent for biopsy. A portion of small intestines is used to create a new storage unit for urine in which both the ureters from the kidneys are connected. One part of this intestine is taken out from the abdominal wall to create a stoma on which a bag is placed for collection of urine. This is a major surgery and patients have to stay in the hospital for 7-8 days.

Cost of radical cystectomy in Delhi at Delhi Urology Hospital starts from Rs. 2,00,000.

In this bladder cancer surgery in Delhi, after removal of urinary bladder and lymph nodes, a new bladder is fashioned from a loop of small intestine which is connected to the urethra. Advantage of this surgery is that patients are still able to pass urine from the natural urine passage and don’t need to apply a urine bag on the tummy permanently. Hospital stay in this surgery is for 7-8 days.

The cost of radical cystectomy in Delhi at Delhi Urology Hospital starts from Rs. 2,00,000.