The gold standard treatment option in muscle invasive bladder cancer is radical cystectomy. Despite unsuccessful outcome of bladder sparing single modality treatment, survival outcome of trimodality treatment with transurethral resection of bladder tumor (TUR-BT), radiotherapy (RT) and cisplatine based chemotherapy, especially appropriate patient selecting,is comparable with radical cystectomy. Current studies are carry on with appropriate dose of radiotherapy and application scheme and treatment with new chemotherapeutic agents.
Clinical criteria helpful in determining ideal patients for bladder preservation include early tumor stage, a visibly complete TURBT, and absence of hydronephrosis. Regular and continuous cystoscopic follow up is mandatory for patients treated with bladder sparing approach. Intravesical treatment options or radical cystectomy may be necessary in the case of recurrent superficial or invasive disease. After radiotherapy session most frequent adverse effects are irritative bladder complaints and bleeding necessitating for cystectomy occurs rarely. Trimodality treatments for bladder sparing approaches may be an alternative option to radical cystectomy with coordination of radiation oncologist, medical oncologist and urologic surgeon.