Department of Urology

Bladder Cancer

Bladder cancer is the 4th most common tumor in men in Germany and the 8th most common tumor in women
In the following, we would like to give you an overview of symptoms, risk factors and background of carcinogenesis.


The urinary bladder serves as a storage organ for the urine continuously produced by the kidneys. We can then purposely deliver the urine at certain intervals by going to the bathroom. The urinary bladder itself is composed of a spherical muscular part (the so-called detrusor muscle), which allows complete emptying of the bladder and an inner layer of the bladder (mucous membrane, mucosa) the so-called urothelium. The bladder is well protected in the bony small pelvis of man.

The urine is first produced by the kidneys and then transported via the ureters into the bladder and finds its entry into the bladder in the area of ​​the two ureteral orifices. An involuntary emptying of the urinary bladder prevents the so-called sphincter, whereby a distinction is made here between an internal and an external sphincter. The external sphincter can be controlled by us at will. (Retention of urine or interruption of the urinary stream). The urine is then given off during urination (the so-called micturition) via the urethra.

The filling volume of a healthy bladder is usually between 300 and 500 ml depending on gender and person.


According to the Robert Koch Institute, bladder cancer is the second most common malignancy in the genitourinary tract after prostate cancer.

Approximately 27,000 new cases are described in Germany alone. Men are about 2.5 times more affected than women.

On average, the peak in females is slightly lower with 70 years compared to the male population with 73 years of age.

Basically, these tumors are assigned to different tissues of origin. The most common tumors in the Western world are the so-called urothelial carcinomas (tumors originating from the mucous membrane of the urinary tract). Therefore, both the bladder as well as the ureters and the inner lining of the kidneys may be affected.

Sometimes these tumors can also affect multiple sites of the urinary tract simultaneously (multifocal), so that always carefully the entire bladder must be examined. It is also necessary to further examine the upper urinary tract by means of computed tomography or MRI or with endoscopic instruments in high risk cancers. It is therefore of the utmost importance from the beginning to carry out a very accurate diagnosis in order to detect all existing tumors and also to bring them to the right treatment as early as possible.

Basically, one differentiates between different growth forms of tumors in the urinary tract. Flat growth forms (such as carcinoma in situ); papillary (warty) tumors or solid tumors in the bladder.


What are the risk factors for the development of bladder cancer?

Risk Factor Number 1 - Smoking

Tobacco use is one of the main risk factors for the development of bladder cancer. Various large retrospective and prospective studies have consistently shown this. The risk of developing a tumor increases with the duration of smoking and the number of cigarettes smoked. One speaks of so-called Pack Years (number of cigarette packs smoked per year)

As with lung cancer, cessation of smoking can prevent further increases in risk

Permanent irritation of the bladder

Different studies have shown an association of cumulative urinary tract infections with an increase in the risk of bladder cancer.

A review presented in Stockholm in 2008 as part of the WHO International Consultation Bladder Cancer from Pathogenesis to Prevention showed that 5 out of 6 studies described an association between urinary bladder cancer risk and urinary tract infections.

Unfortunately, prospective studies on this topic are not available. In addition, long term use of indwelling catheters was able to demonstrate an increased bladder carcinoma risk in paraplegics, which is why special attention is required here.

Aromatic amines

So called aromatic amines are found in various solvents and colors, etc. The individual representatives of this group of substances differ significantly in their cancer-causing potential.

With regard to the triggering of a bladder cancer in humans in the sense of an occupational disease BK 1301, aromatic amines of category 1 are of particular interest.


Radiation therapy in the pelvis (for example in the context of a prostate carcinoma) can lead to the development of a bladder carcinoma with a latency period of several years.

Especially in older patients, who were curatively irradiated decades ago with a technology that is obsolete from today's perspective, a bladder carcinoma should be considered as a long-term consequence, if appropriate symptoms are present.

Source: S3 Guideline for bladder carcinoma


The most alarming symptom of bladder cancer is the presence of blood in the urine (the so-called painless gross hematuria). Most patients report a reddish to brown coloration of the urine caused by bleeding from the urinary tract. Even a single episode of gross hematuria can be considered pathological.

If gross hematuria is present, a urologist should be consulted to determine the origin of the bleeding and to be able to initiate the correct therapy quickly.


The old 2004 WHO classification on tumors of the urogenital system was updated in February 2016.


Our specialist

Prof. Dr. Alexander Karl, Professor and Chair, Department of Urology

Consultation Hours

Thursday 8:30 - 15:00

To schedule an appointment or if you have questions:
Heike Mylius
Sophia Schottenhammel
Phone +49 (0)89 1797-2603
Fax +49 (0)89 1797-2623