Bladder cancer: deciding on appropriate surgery

Over the last 40 years the role of surgery in the management of bladder cancer has evolved from being the only treatment option to part of a multimodality approach which utilizes intravesical and systemic chemotherapy. Throughout this evolution, surgery has remained the mainstay of staging and treatment. Currently, conservative bladder-sparing endoscopic surgery is possible in patients with superficial bladder cancer, and continent cutaneous or orthoptic diversions are improving the quality of life in many patients who require a radical cystectomy. Unfortunately, surgery alone is insufficient to cure advanced stages of bladder cancer. Continued research in systemic chemotherapy is necessary to significantly improve long-term survival rates.