The value of bladder-conserving strategies in muscle-invasive bladder carcinoma compared with radical surgery.
OBJECTIVE
Patients with muscle-invasive bladder cancer will practically all develop progression, often associated with severe side effects including pain, dysuria or macrohematuria. Recent reports demonstrate multimodality bladder-sparing approaches as primary treatment for muscle-invasive bladder cancer.


RESULTS
Bladder-conserving strategies include thorough transurethral resection of the bladder tumor, external beam radiation therapy and chemotherapy. It has been shown that survival rates are similar to those of radical cystectomy series; additionally, a substantial number of patients survive with an intact bladder. The high costs, close cooperation between clinical specialists and a highly compliant patient need to be taken into consideration, however.


CONCLUSIONS
Nowadays, the good long-term results after radical cystectomy with the creation of an orthotopic neobladder make the substantial advantage of a bladder-preserving strategy questionable when the patient's quality of life is addressed. Multimodality bladder-conserving strategies are a therapeutic option for selected patients; however, radical cystectomy remains the gold standard of treatment.
Merseburger
Axel S
AS
Department of Urology, Eberhard-Karls-University, Tübingen, Germany.
Kuczyk
Markus A
MA
D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D015653:Cystectomy / Q000379:methods* / Q000639:trends; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D009132:Muscles / Q000473:pathology / Q000601:surgery*; D009361:Neoplasm Invasiveness; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*
D000970:Antineoplastic Agents