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Abstract
Bladder cancer is the second most common malignancy in urological field. Most new cases are diagnosed as non-muscle invasive bladder cancer (NMIBC), which includes Ta, T1 or carcinoma in situ. Initial management of NMIBC is endoscopic resection, which allows both treatment and pathological staging. Urologist should consider adjuvant intravesical chemotherapy or Bacillus Calmette-Guerin (BCG) immunotherapy, depending on the tumor grade or stage to prevent recurrence and progression. Patients with muscle invasive bladder cancer (MIBC) are best treated with radical cystectomy. However, radical cystectomy should be considered even in patients with NMIBC with high risk of progression and BCG refractory tumors. Delay of radical cystectomy in these patients might lead decreased disease specific survival. Patients treated by radical cystectomy should undergo any form of the urinary diversion. Ileal conduit is still most common method for urinary diversion. Orthotopic neobladder is generally performed by experienced hands in high volume center. Patients undergoing orthotopic neobladder should be educated and manually skillful to manipulate their diversion. Neoadjuvant cisplatin-based chemotherapy is recommended based on level 1 evidence with survival benefit. Recent updated meta-analysis also demonstrated survival benefit in patients with MIBC treated by adjuvant chemotherapy.
Figures and Tables
Fig. 1
Non muscle invasive bladder cancer. (A) Cystoscopy reveals papillary bladder tumor (BT), located lateral to the left ureteral orfice. (B) The bladder mass (arrow) is detected in computed tomography on the left posterior wall of the urinary bladder with enhancement. BT, bladder tumor.
Fig. 2
Orthotopic neobladder formation using Studer method. (A) Ileal neobladder is consisted of afferent tubular limb and spherical reservoir. Afferent tubular limb is used for ureteral implantation and prevents ureteral reflux using bowel peristalsis. Spherical reservoir is formed by detubularization and four-cross folding of ileal segments to maximize bladder capacity and minimize intra-luminal pressure. (B) Most caudal part of the ileal neobladder is anastomosed to urethra over the urethral catheter. L, afferent tubular limb; R, spherical reservoir; N, neobladder; U, urethra.
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