[Radical cystectomy and urinary diversion in elderly patients with increased comorbidity]

Radical cystectomy with urinary diversion is the accepted standard of care for invasive bladder cancer with orthotopic neobladders. It is the preferred method for bladder substitution in male and female patients and even in selected patients with locally advanced tumors. The complication rates for orthotopic bladder substitutes are similar to or lower than the morbidity rates after conduit formation or continent cutaneous diversion. Due to progress in perioperative management, intensive care and surgery, cystectomy is now part of the classical treatment options for bladder cancer in elderly patients, with acceptable morbidity rates. However, the indication for cystectomy in people older than 75 years should be based on a rigorous preoperative risk assessment (ASA status) and a life expectancy of more than 2 years independent of the tumor. Transurethral resection alone should be proposed only to patients with a poor performance status.