Bladder preservation protocols in the management of muscle-invasive bladder cancer: A systematic review

Bladder cancer is one of the most common cancers worldwide causing a significant burden on healthcare system and society. Muscle-invasive bladder cancer (MIBC) is highly fatal, and if untreated, >85% of patients die within 2 years of diagnosis. Although radical cystectomy (RC) is the preferred treatment of choice in patients with MIBC, bladder preservation can be considered in patients who are either not eligible for cystectomy or are not willing to undergo cystectomy. The goal of bladder preservation is to achieve cancer survival at least equivalent to RC and to maintain better quality of life including sexual function. Strategies for bladder preservation include partial cystectomy, radical transurethral resection, radiation therapy, and chemotherapy. It is widely accepted that combination of these approaches could result in better outcomes in patients with MIBC. In this review, we describe different approaches for bladder preservation and their outcomes.