Surgical bladder-preserving techniques in the management of muscle-invasive bladder cancer

Bladder preservation surgical strategies for the treatment of invasive bladder cancer have been developed to provide options to those patients who are medically unfit to undergo radical extirpative surgery or prefer conservative therapy for limited disease. The purpose of this manuscript is to review the available bladder-preserving surgical techniques for treatment of muscle-invasive bladder cancer.

We performed a thorough literature search to determine the available bladder-preserving treatments for muscle-invasive bladder cancer as well as their corresponding outcomes.

Available surgical strategies include radical transurethral resection (TUR) with or without neoadjuvant chemotherapy, partial cystectomy and multi-modal therapy. Patient selection is critical in determining which patients can safely be offered bladder preservation therapies. Disease characteristics that portend more favorable outcomes in the setting of bladder preservation include cT2 stage, unifocal tumor, the absence of carcinoma in situ and hydronephrosis, and complete TUR. Several new technologies, including fluorescence and cryoablation treatment, have been incorporated into existing treatment modalities to improve surgical precision and margins. Ongoing studies aimed at improving the accuracy of clinical staging can further refine patient selection and improve clinical outcomes.

Surgical bladder preservation techniques for treatment of invasive bladder cancer requires careful, long-term follow-up. Prospective, randomized studies comparing bladder sparing treatment modalities with radical cystectomy are needed, but ultimately will be difficult to accrue due to a variety of factors.