ABSTRACT
The primary mode of therapy for muscle-invasive bladder cancer is radical cystectomy and
lower urinary tract reconstruction. Over the past several decades numerous advances in chemo-
therapy, intravesical immunotherapy, and bladder preservation protocols have been identified
in the treatment of bladder cancer. However, none of these treatment modalities are able to
achieve the survival rates of primary surgical management in the patient with invasive bladder
cancer. As we enter the 21st century, urinary diversion after radial cystectomy has reached a
new era. The ultimate goal of lower urinary tract reconstruction has become not only a means
to divert urine and protect the upper urinary tract, but also to provide patients a continent
means to store urine and allow for volitional voiding through the intact native urethra. These
advances in urinary diversion have been made in an effort to provide patients a more normal life-
style and positive self-image following cystectomy. In addition, these advances have lessened the
impact of surgery and allowed for a more aggressive approach in patients with higher grade (but
less invasive) lesions as well as patients with carcinoma in situ refractory to intravesical therapy.
