title: [Alternatives to cystectomy].
abstract: BACKGROUND
  In many cases radical cystectomy is not feasible in patients suffering from muscle-invasive bladder cancer due to advanced age of the patient or limiting comorbidities which increase the perioperative risk. A further group of patients decline radical cystectomy due to potential postoperative complications and the resulting impairment in the quality of life.
  
  
  OBJECTIVE
  This article provides an overview of alternative therapeutic concepts to radical cystectomy in muscle-invasive bladder cancer.
  
  
  METHODS
  The study involved a database analysis and gives a discussion of clinical trials concerning alternative therapeutic concepts for muscle-invasive bladder cancer treatment strategies.
  
  
  RESULTS
  Transurethral resection, open partial cystectomy, radiotherapy, chemotherapy and combined therapeutic regimens are available as alternatives to radical cystectomy.
  
  
  CONCLUSIONS
  Radical cystectomy is the accepted standard of care in the treatment of muscle-invasive bladder cancer but in selected patients, established alternative methods can also be offered. A comprehensive patient information and counseling is therefore necessary to find the best therapeutic option in each individual case. Salvage cystectomy is a therapeutic option in cases of failure of organ-preserving treatment.
authors.affiliation: Klinik für Urologie und Kinderurologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Deutschland, christian.niedworok@uk-essen.de.
authors.forename: C
authors.initials: C
authors.lastname: Niedworok
authors.forename: C
authors.initials: C
authors.lastname: Gratzke
mesh_terms: D059248:Chemoradiotherapy / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D015653:Cystectomy / Q000379:methods*; D019317:Evidence-Based Medicine; D006801:Humans; D019042:Muscle Neoplasms / Q000473:pathology* / Q000628:therapy*; D009361:Neoplasm Invasiveness; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery