[Muscle-invasive bladder cancer]

Muscle invasive bladder cancers represent 20 to 30% of bladder tumors and are metastatic at diagnosis in 10% of cases. The diagnosis is based on histological analysis of transuretral resection pieces. An invasion of the detrusor (stage pT2) signs the infiltrating nature of the tumor. The local and general staging is based on thoraco-abdominopelvic CT. The standard treatment for localized stages is cystoprostatectomy in men and anterior pelvic exenteration in women. For urinary diversion, the two choices are cutaneous non continent ileal conduit (Bricker) and ileal neobladder. Neoadjuvant chemotherapy can be discussed for locally advanced stages. The concomitant chemoradiotherapy is an alternative to surgical treatment in elderly or frail patients. The management of metastatic bladder cancer is based on systemic chemotherapy.