The main symptom of bladder cancer is hematuria. Less common symptoms are pain during urination (dysuria) or frequent urination. As a result, each case of hematuria in older ages should be examined by the urologist with the suspicion of bladder cancer. Imaging examination, such as ultrasound of the bladder and abdominal CT, and the urine cytology are the useful tests for the diagnosis of bladder cancer. Nevertheless, cystoscopy is the most important examination. The latter is performed by inserting a special instrument through the urethra into the bladder and the urologist evaluates the appearance of the bladder mucosa. The examination is not painful when carried out under local or general anesthesia. Therefore, the diagnosis of bladder cancer most often arises after cystoscopy and visual recognition of the characteristic image of exophytic tumor. Urine cytology significantly contributes to the diagnosis since cancer cells are detected in the urine. The final diagnosis is set by the histological examination of biopsy samples taken from the tumor. A biopsy will also determine the aggressiveness of the tumor and the extent of bladder wall involvement. It is worth noting that for small lesions with low aggressiveness, the complete resection of the tumor for biopsy could be also the definitive treatment.

Complications are limited when the surgery is performed in a specialized center with extensive experience. The most common complications are postoperative ileus, fever, and leakage of urine. These complications are in the majority of cases treated conservatively. However, in limited number of cases, a reoperation could be required. Other complications are disturbed wound healing, thrombosis or embolism, injury of adjacent organs and lymphocele. Mid-term complications include ureteral strictures at sites where the ureter is sutured to bowel, compromised renal function, formation of kidney stones and infection.

Superficial bladder tumors are treated with transurethral resection (transurethral resection of the bladder tumor (TURBT)). Depending on the stage and aggressiveness recurrence rate could be as high as 80% after initial treatment. The periodically repeating cystoscopy with ablation is often sufficient in low-grade tumors. Alternative means such as repeated injections of chemotherapeutic agents into the bladder are necessary to address intermediate grade tumors. The injections significantly reduce the recurrence rates and the incidence of tumor progression to more aggressive neoplasm. In case of tumors extending to muscular layer or across the bladder wall, transurethral resection is not sufficient. These patients are candidates for radical cystectomy (removal of the bladder with simultaneous removal of the regional lymph nodes) if there is no evidence of distant metastasis. Systemic chemotherapy and local radiation therapy adjunct or in combination to radical cystectomy are indicated for more advanced disease or to the patients that are not fit or are not willing to undergo radical cystectomy.

Radical cystectomy is considered to be one of the most demanding urologic procedures. It can be performed by open or laparoscopical approach. Despite the higher technical challenge of laparoscopic cystectomy in comparison to open surgery, the laparoscopic approach is associated with less perioperative morbidity and faster recovery. The surgery involves the complete removal of the bladder along with fatty tissue around the bladder and lymph nodes. In addition, the prostate and seminal vesicles are removed in male patients while the uterus, fallopian tubes, ovaries as well as the anterior vaginal wall are removed in the female patients. An appropriate procedure to restore the urinary tract is concomitantly performed in order to restore the urinary tract. There are several different techniques to restore the urinary tract. These techniques depend on the stage of the disease and can be categorized into continent and incontinent urinary diversion groups. In continent urinary diversion a bowel segment is used to form a pouch which can be further joined to urethra forming artificial neobladder. This provides the patient the restoration of the normal urinary function in most of the cases. In case of incontinent urinary diversion, the ureters are either joined directly to the skin or to the use of small bowel segment. In either case urine is drained continuously into the urostomy bag attached on the abdominal wall on one side or on both sides

Laparoscopic radical cystectomy is associated with significantly faster recovery of the patient in comparison with open cystectomy. The patient is mobilized on the next day of surgery and fed with the return of normal bowel on the fourth postoperative day. Discharge day is scheduled one week after surgery while ureteral catheters (inserted intraoperatively) are removed 2 weeks after surgery.