Kathmandu Medical college and Teaching Hospital / Nepal cancer Hospital
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The incidence of Urinary bladder carcinoma increased with age and affects men more than women. Treatment of MIBC, recurrent CIS, recurrent high grade T1 or BCG failure NMIBC is radical cystectomy with pelvic lymphadenectomy as standard of care.
Organ preservation surgery is being utilized with the aim of reducing surgical morbidity without hampering quality of life. Organ preservation is rational only when cancer outcomes are not compromised when compared to radical resection. Trimodality therapy(maximum TURBT, chemotherapy, and radiotherapy) for MIBC of blabber has long been there since 90s but level 1 evidence of it being superior has never been there. Randomized control trials comparing trimodality treatment and radical cystectomy is needed. Moreover, optimal bladder function after maximum TURBT, recurrences and need for salvage radical surgery are major issues of organ preservation and trimodality therapy. Currently , bladder preservation can be considered as an alternate treatment for very selected cases provided they are kept on appropriate active surveillance