Surgical treatment in urinary bladder cancer

Abstract

There are multiple treatment options in the surgical management of bladder cancer. It is important to know the histological diagnosis, cancer staging, and other prognostic factors (cancer grade, multifocality, size, and presence of carcinoma in situ) in the decision of surgical treatment. Transurethral resection of bladder tumor is the first surgical treatment option. It is important to know tumor size, anatomic location, and other urothelial abnormalities. Re-staging transurethral resection is mandatory in patients who have an incomplete resection without detrusor muscle in original specimen, if the tumor is large, high grade, or multifocal. Partial cystectomy is sometimes utilized as bladder-sparing surgery in the setting of urachal carcinoma. Radical cystectomy is considered the standard of therapy for muscle-invasive bladder cancer. In men, radical cystectomy includes removal of the prostate and seminal vesicles, while it includes removal of the uterus, ovaries, and part of the vagina in women. Bilateral pelvic lymphadenectomy is important for the staging and treatment of invasive urothelial cancer. Neoadjuvant chemotherapy should be considered for advanced disease.