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Radical cystectomy and bladder-sparing treatments for urothelial bladder cancer

Andrew J Stephenson, MD
Section Editor
Seth P Lerner, MD
Deputy Editor
Michael E Ross, MD


Radical cystectomy and urinary diversion have been the mainstay of treatment for muscle-invasive urothelial (transitional cell) bladder cancer for decades and remain the standard by which other treatments are judged. In addition, randomized trials have shown that neoadjuvant cisplatin-based chemotherapy (followed by bladder surgery) results in improved survival outcomes for some patients compared with primary surgery (and adjuvant treatment).

Beyond patients with a primary diagnosis of muscle-invasive bladder cancer, radical cystectomy also has a role in carefully selected patients with non-muscle invasive disease, as well as in patients with locally advanced or metastatic bladder cancer who achieve a major clinical response to cisplatin-based chemotherapy.

The role of radical cystectomy as the initial treatment and its use in conjunction with neoadjuvant chemotherapy, along with the role of alternative surgical procedures, will be discussed here. An overview of the treatment of urothelial bladder cancer is presented separately. (See "Overview of the initial approach and management of urothelial bladder cancer".)


The indications for radical cystectomy and the surgical technique are reviewed below.

Indications — There are multiple indications for cystectomy among patients diagnosed with bladder cancer. These include:


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Literature review current through: Sep 2016. | This topic last updated: Jun 6, 2016.
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