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  • Review Article
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Management of muscle-invasive bladder cancer: an update

Nature Clinical Practice Urology volume 5, pages 501–508 (2008)Cite this article

Abstract

The aim of this Review is to critically assess the currently used methods for the treatment of muscle-invasive bladder cancer. Radical cystectomy seems to be the gold standard for the treatment of bladder cancer, and the optimum extent of lymph-node dissection has now been identified. An early cystectomy should be carried out once a diagnosis of muscle invasion is established. Preoperative radiation is no longer popular, but could be due a reassessment in view of technical advances. Results of neoadjuvant and adjuvant chemotherapy trials are subject to criticism. Most trials are retrospective, used different chemotherapy protocols and did not have uniform end point assessment. Bladder-preservation strategies can offer cures for a selection of subpopulations, but these patient groups have yet to be clearly defined. Developments in molecular biology are exciting, and their potential application is pending translational research. To be meaningful and useful, future trials that involve additional or alternative modalities should be prospective, randomized and adequately powered.

Key Points

  • Radical cystectomy remains the gold standard for the treatment of muscle-invasive bladder cancer

  • An early cystectomy after the diagnosis of muscle invasion should be promoted

  • To ensure adequate radical cystectomy with meticulous pelvic lymphadenectomy, the removal of about 20 nodes is recommended

  • Laparoscopic cystectomy should be undertaken with the same quality-control criteria

  • To be useful and meaningful, future clinical trials involving newer chemotherapeutics and/or bladder-sparing strategies should be prospective, randomized and adequately powered

  • Recent developments in molecular biology are promising, and clinicians should follow the results of translational research

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Author information

Authors and Affiliations

  1. MA Ghoneim is Professor of Urology, University of Mansoura, Mansoura,

    Mohamed A Ghoneim

  2. H Abol-Enein is Professor of Urology and Director of the Urology–Nephrology Center, Mansoura, Egypt.,

    Hassan Abol-Enein

Authors
  1. Mohamed A Ghoneim
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  2. Hassan Abol-Enein
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Corresponding author

Correspondence to Mohamed A Ghoneim.

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Competing interests

The authors declare no competing financial interests.

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Ghoneim, M., Abol-Enein, H. Management of muscle-invasive bladder cancer: an update. Nat Rev Urol 5, 501–508 (2008). https://doi.org/10.1038/ncpuro1202

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  • DOI: https://doi.org/10.1038/ncpuro1202

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