Our expertise in bladder cancer

I suddenly had blood in my urine, without any warning. Lots of blood and every time I urinated. I didn't have any pain, but it was a shock. That was in May 2021.

My first appointment was with my GP. He referred me to a urologist, and the ultrasound examination was followed by a suspected diagnosis: several tumors in the bladder.

I was called in three times for tumor removal at Liestal Cantonal Hospital, where a transurethral resection of the bladder tumor was performed each time.

When the samples were taken, it was discovered that the tumor had already attacked the muscle tissue; as a result, further treatment options were discussed at an interdisciplinary tumor conference with a team of specialists from urology, oncology, radiotherapy and radiology.

Bladder tumors are usually diagnosed by cystoscopy, which is used to determine the indication for transurethral resection (removal of bladder tumors with an electrosurgical snare via the urethra) (Editor's note).

I had my first appointment with PD Dr. Jan Ebbing at the Department of Urology at the University Hospital Basel in August 2021, accompanied by my wife.

It was explained to us that, in addition to chemotherapy, a complete removal of the bladder was necessary as the tumor had already grown into the muscles of the bladder.

Dr. Ebbing also discussed the various forms of urinary diversion with us (urinary stoma/conduit versus neobladder). We discussed the necessary requirements, the specific features of urinary diversion and the associated surgical risks.

I opted for the neoplasia. It was also decided that I would undergo chemotherapy first in order to be able to treat the tumor even better.

I was able to receive chemotherapy at Liestal Cantonal Hospital, for a total of four cycles. After the first cycle I still felt quite well, but after the second cycle I was struggling with skin rashes and exhaustion. And I was constantly cold. The freezing persisted and I still go to bed very early at night.

The neobladder surgery was performed successfully and without complications here at the USB by PD Dr. Jan Ebbing and Dr. Abolfazl Hosseini in January 2022.

The indication for chemotherapy is always individualized and patient- and tumor-specific. Side effects of chemotherapy occur and are discussed with the patient by the treating oncologists during the information session prior to treatment (editor's note).

A diagnosis like this turns everything upside down at first. You feel insecure and scared. But my family, my daughters, had greater difficulties accepting the diagnosis.

However, the most valuable and important thing is the support at home. I was informed about existing external support services, but I didn't want to take advantage of them. I am coping well.

At the USB, all tumor patients are psycho-oncologically evaluated and also receive psychological support on request (editor's note).

The pain was severe, but I'm good with pain. I was able to bear it. Mentally, you feel insecure and I also felt somehow at the mercy of others.

Pain can occur after bladder removal surgery, but there is good pain management. The minimally invasive approach and the use of robot-assisted keyhole surgery in particular significantly reduce the trauma to the body, which is associated with a faster recovery for patients and fewer complications (editor's note).

Later, after the bladder catheter was removed from the neobladder and the bladder filled with urine for the first time, I struggled with sleep deprivation. I had to set the alarm clock at night, first every two, then every three hours, so that there was no overloading with the new bladder. However, the accompanying pelvic floor therapy went well.

A neobladder has no sensitivity and no motor activity. The urine volume must first be trained. It is therefore normal for patients to initially have to empty their neobladder at night and set an alarm clock. Around 30% of male patients and 40% of female patients with a neobladder remain incontinent at night (more than 1 insert), whereas around 97% of male patients and around 75% of female patients are dry during the day (0 to a maximum of 1 insert per 24 hours), without restrictions (editor's note).

Yes, it seemed like the best option for me right from the start.

I always felt well supported and looked after here at the University Hospital Basel.

I was able to return to work in May 2022. Everything works well during the day and I have no problems or complications. At night (when my head isn't thinking) I have to wear insoles. I no longer have to take any medication. With the exception of erection support.

If the tumor situation allows, the erectile nerves, or the nerves for sexual stimulation, can be spared during bladder removal so that sexual function is maintained after a rehabilitation phase. However, additional medication may be necessary to support the erection (editor's note).

I am called in for a check-up every six months and then once a year. So far, everything has been normal.

The follow-up intervals depend on the patient's tumor situation and the current guidelines of the specialist associations, such as the European Association of Urology (EAU) (editor's note).

Communicate openly with family and friends. I felt the need to spare my loved ones and family, but open conversations were the best way to help everyone deal with the illness.

Even with work colleagues and acquaintances, there were those who avoided me and those who asked directly how I was doing. I was able to give a direct answer, and that was always really good.

It all started with a painful hip in the fall of 2022, when I was in the USA on business. I came back to Switzerland and had to undergo hip surgery in December. Following the operation, blood was found in my urine, a typical symptom of bladder cancer.

The diagnosis after the CT confirmed the suspicion of a bladder tumor. I was unable to return to the USA, and I am still unable to work regularly. However, this is only partly due to the bladder tumor and the associated treatment.

In January 2023, I had my first operation in a Basel hospital outside the USB. The first TUR-B (transurethral resection of bladder tissue) was followed by a resection.

In March, a BCG (Bacillus Calmette-Guérin) instillation into the bladder was started there. After the third instillation, my knee and calf swelled up. A side effect of the instillation that was not recognized as such. This was followed by an operation on my knee and a puncture in my hip. The BCG therapy had to be discontinued.

Three small tumors were discovered during a cystoscopy at the end of May. Two tumors were superficial, one tumor turned out to be a carcinoma in situ (CIS) with a high risk of recurrence.

This marathon of doctors and diagnoses is extremely stressful and tiring. My daughter accompanied me to the appointments a few times. Of course, you also try to gather information yourself via all available channels.

I also sought external psychological help. But only for a short time. Ultimately, you have to deal with the illness on your own. I also try not to burden my family too much with it.

I also had to learn that the emotional life during such treatment is not so easy to explain and that you shouldn't underestimate the psychological strain.

After the second TUR-B, I received a first instillation of epirubicin at an external hospital. This is the standard therapy.

In August 2023, a referral to Prof. Cyrill Rentsch at the University Hospital Basel was discussed at the external tumor board. Here at the Urology Clinic, a local gemcitabine/docetaxel combination therapy is offered , which is more promising than epirubicin. The therapy was then started immediately.

The procedure for the instillation cycle was as follows: For six weeks, I received alternating doses of chemotherapy flushed into the urinary bladder on two consecutive days. On the first day a dose of gemcitabine, on the following day a dose of docetaxel. This was followed by a four-week break.

Subsequently, after a cystoscopy without new evidence of cancer, monthly maintenance therapy was started.

We had the first consultation after the appointment for the last round of instillations. The patient appears athletic, open, composed, but also tired. This is one of the side effects that he struggles with in the first 3-5 days after instillation. Exhaustion and nightmares also bother him.

After many visits to the doctor and stays in various hospitals, I had to readjust to the University Hospital Basel. The USB is a big place, so you can feel like one of many. But the priority is to get the right treatment. This is the case here.

I feel that I am in good hands with my attending physician, Prof. Cyrill Rentsch. My thanks also go to Heike Püschel, Study Nurse, who looks after me with great empathy during every examination. This is extremely valuable.

I am currently on maintenance treatment. For 12 months, I come to the clinic every month on two consecutive days and receive a dose of Gemcitabine on the first day and a dose of Docetaxel on the second day.

To date, the findings are: no visible tumors.

For me, it's important to feel my body and keep moving. In my case, swimming and running training sessions helped me a lot to forget about the tumor, at least temporarily.

That's what I would say to someone living with a similar diagnosis - don't let up, fight. And believe in yourself.

The main risk factor for bladder cancer is smoking. Stopping smoking can have a positive effect on the relapse and progression of bladder cancer . Read more about our stop smoking consultation at the USB.

The first signs are pain when urinating and frequent urination. However, the main symptom is visible or non-visible, painless blood loss in the urine. Patients with these symptoms should definitely be seen by a urologist.

If bladder cancer is suspected, we will perform a cystoscopy. Nowadays, this procedure can be performed on an outpatient basis and without anesthesia during consultation hours thanks to the use of a flexible camera. A cystoscopy only takes a few minutes. We will also perform a bladder irrigation to examine whether malignant bladder mucosa cells can be found. If these examinations reveal any abnormalities, a tissue sample is taken from the bladder through the urethra in a minimally invasive procedure without a skin incision.

If a bladder tumor is found in the cystoscopy, it is removed through the urethra under anaesthetic. When first diagnosed, most bladder tumors are limited to the mucous membrane (70%) and the bladder can be preserved.

Urinary bladder tumors limited to the mucous membrane have a high risk of recurrence. To reduce this risk, after removal of the tumors, medication is injected into the bladder via the urethra at regular intervals using a catheter to reduce the risk of recurrence. Read more about our instillation therapy.

If the cancer has already grown into the muscles of the bladder when it is first diagnosed, the bladder must be surgically removed or treated with radiotherapy and chemotherapy.

Read more about robot-assisted cystectomy, radiotherapy and chemotherapy.

If the bladder is completely removed, urine can no longer be excreted naturally via the urethra. A replacement for urine drainage from the kidneys is created.

In rare cases, however, bladder cancer has already spread throughout the body. In this case, cure by surgery and radiotherapy is no longer likely. However, there are good therapies that can greatly prevent further progression of the disease.

The earlier bladder cancer is detected, the higher the chances of recovery. In many cases, the entire bladder cancer can be removed with a tissue sample via the urethra. If the tumor has not yet grown into the muscle layer of the bladder, the chances of recovery are around 80%.

Depending on how deep the cancer has penetrated into the bladder wall and how malignant it is, it may be necessary to remove more of the bladder mucosa.

Unfortunately, non-muscle-invasive bladder cancer often returns even after complete removal.

Our clinic has extensive experience in advanced bladder tumor therapy. BCG immunotherapy (Bacillus Calmette-Guérin) can significantly reduce the likelihood of bladder tumors returning. We are actively conducting research in the field of BCG immunotherapy and are supported by the Swiss Group for Clinical Cancer Research (SAKK).

We offer our patients individual tumor follow-up care in order to detect bladder tumor recurrences at an early stage and treat them accordingly.

Urology registration office
Availability: Mon-Fri, 08.00 - 16.00 hrs

Phone +41 61 265 72 80
anmeldung.urologie@usb.ch

Contact for emergencies
During operating hours, please contact the Urology Registration Office. For urological emergencies outside of operating hours, the Emergency Center at the USB is there for you around the clock:
Emergency Center University Hospital Basel
Petersgraben 2
4031 Basel
Phone +41 61 265 25 25

Contact for queries about your operation
Surgery Coordination Urology
Phone +41 61 328 58 15
op.urologie@usb.ch