ABSTRACT
Introduction Radical cystectomy is the gold standard of therapy for patients with muscle-invasive bladder cancer. Although the quality of life of patients treated with radical cystectomy has improved substantially with the use of orthotopic, continent urinary diversions and preservation of sexual potency in selected cases, morbidity is high and there is no doubt that patients with their own bladders, even after undergoing one or more transurethral resections of the bladder (TURBs), have less morbidity and a better quality of life than patients treated with cystectomy. For this reason, bladder preservation programs have been developed for patients with muscle-invasive bladder cancer.1-3 TURB is a fundamental procedure for the diagnosis and staging of bladder cancer. However, TURB alone is controversial as a therapeutic approach to invasive bladder cancer due to the different patterns of tumor spread (frontal, tentacular) and the presence of microfoci, both surrounding and at a distance from the primary tumor. This makes it difficult to achieve complete tumor resection. Nevertheless, retrospective studies of TURB alone have demonstrated the feasibility of this approach in patients with low invasive disease. In selected series, 5-year survival rates ranging from 31% to 53% have been reported.4,5
Rationale In large series, the incidence of attaining P0 at cystectomy is approximately 12%.6-9 The lack of residual cancer suggests that in some instances patients may be overtreated by cystectomy and that the tumor was completely controlled with TURB during the diagnostic work-up.
