Advances in the diagnosis and treatment of bladder cancer

There have been major advances in the diagnosis and treatment of bladder cancer in the last several years. Flexible cystoscopy and DNA analysis have combined to increase both comfort for the patient and detection rates of early disease. The laser has become an established alternative to transurethral resection of superficial tumors, providing identical cure rates, but with more comfort and less expense. Intravesical installation of BCG has become not only an alternative treatment for recurrent superficial bladder cancer, but the first line of treatment for diffuse carcinoma in situ of the bladder which previously had been best treated with radical cystectomy. There are now numerous alternatives to the ileal conduit, when radical cystectomy is the preferred treatment. Herein we describe the "Providence Pouch," our own variation on the theme. Lastly, metastatic disease, once universally fatal, is now responding to a new combination of chemotherapy agents based on a combination of cisplatinum and methotrexate.