Surgical therapy for locally advanced bladder cancer.

Radical cystectomy followed by a urinary diversion or an orthotopic neobladder remains standard treatment for patients with muscle-invasive bladder cancer. The advances in surgical technique and reconstructive options allow many patients to enjoy a high quality of life after surgical extirpation. For those unable or unwilling to undergo a radical cystectomy, several treatment alternatives exist, using aggressive TUR and combinations of chemotherapy and/or radiation. Continued investigations into the biological behavior of this malignancy, as well as the identification of more effective chemotherapeutic agents, will allow more definitive treatment approaches with improved outcomes.