For patients with invasive bladder cancer who are physically unable to tolerate radical cystectomy or who do not wish to undergo radical cystectomy, bladder preservation may be considered as a comprehensive treatment. Given the high percentage of lymph node metastases in invasive bladder cancer, patients considered for bladder-preserving treatment need to be carefully selected and evaluated for the nature of the tumor and the depth of infiltration, and the correct bladder-preserving surgical approach should be selected, supplemented with postoperative radiation therapy and chemotherapy, and closely followed up after surgery.
There are two types of bladder preservation surgery for invasive bladder cancer: transurethral resection of bladder tumor (TUR-BT) and partial cystectomy. For most patients with bladder-preserving invasive bladder cancer, the tumor can be removed by the transurethral route. However, partial cystectomy should be considered for some patients: those with tumors located within the bladder diverticulum, around the ureteral opening or in the blind area of the transurethral surgical operation, those with severe urethral strictures and those who cannot tolerate the amputation position. Recently, it has been suggested that for patients with stage T2, a repeat TUR-BT within 4-6 weeks after the initial TUR-BT and combined with chemotherapy and radiotherapy can help preserve the bladder.
Since the ideal bladder preservation cannot be achieved with a single treatment, the current comprehensive treatment for bladder preservation is mostly a triple combination of surgery, chemotherapy and radiotherapy. The indications for the selection of this treatment regimen must be strictly controlled and the patient must have good compliance in order to obtain a better treatment outcome. Studies have shown that patients treated with TURBT followed by cisplatin-based chemotherapy regimens and radiation therapy can achieve a treatment efficiency of 60-80%. However, patients must be closely monitored and treatment regimens must be adjusted in a timely manner. The overall survival rates for patients with invasive bladder cancer treated with bladder-sparing combination therapy are 45-73% at 5 years and 29-49% at 10 years.