High-stage bladder cancer: bladder preservation or reconstruction?

The availability of potentially effective systemic chemotherapy for transitional cell carcinoma of the bladder and the functional improvements afforded by new methods of urinary diversion have both contributed to significant changes in the treatment of high-stage bladder cancer. The clinician must decide at the beginning of therapy whether to use a bladder-preservation or bladder-reconstruction approach. The decision may be based on survival or on quality of life--two different goals that require different studies. When multiple types of treatments are combined, cumulative toxicity must be examined carefully.