What are EAU recommendations for radical cystectomy in the treatment of bladder cancer?

Updated: Feb 23, 2021
  • Author: Kara N Babaian, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Radical cystectomy:

  • Do not delay radical cystectomy for > 3 months, as that increases the risk of progression and cancer-specific mortality.
  • In hospitals where radical cystectomy is offered, at least 10, and preferably > 20, of the procedures should be performed annually.
  • Do not offer sexual-function–preserving radical cystectomy to men as standard therapy for MIBC; offer these techniques to men motivated to preserve their sexual function, since the majority will benefit. Select male patients based on organ-confined disease, with absence of any kind of tumor at the level of the prostate, prostatic urethra, or bladder neck.

  • Do not offer pelvic organ–preserving radical cystectomy to women as standard therapy for muscle-invasive bladder cancer. Select female patients based on organ-confined disease, with absence of tumor in bladder neck or urethra.

  • Do not offer an orthotopic bladder substitute diversion to patients who have a tumor in the urethra or at the level of urethral dissection.

  • Preoperative bowel preparation is not mandatory. "Fast track" measurements may reduce the time to bowel recovery.
  • Perform a lymph node dissection as an integral part of radical cystectomy.    
  • Do not preserve the urethra if margins are positive.
  • Offer pharmacological prophylaxis, such as low molecular weight heparin, to patients who have undergone radical cystectomy, starting the first day post-surgery, for a period of 4 weeks.

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