What are the indications for radical cystectomy?

Updated: Nov 27, 2016
  • Author: Michael Christopher Large, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Indications for radical cystectomy include the following:

  • Infiltrating muscle-invasive bladder cancer without evidence of metastasis or with low-volume, resectable locoregional metastases (stage T2-T3b)

  • Superficial bladder tumors characterized by any of the following:

    • Refractory to cystoscopic resection and intravesical chemotherapy or immunotherapy (Up to 71% of these patients may progress to stage T2 within 5 years of initial recurrence. [5] )

    • Extensive disease not amenable to cystoscopic resection

    • Invasive prostatic urethral involvement

  • Stage-pT1, grade-3 tumors unresponsive to intravesical BCG vaccine therapy

  • CIS refractory to intravesical immunotherapy or chemotherapy

  • Palliation for pain, bleeding, or urinary frequency

  • Primary adenocarcinoma, SCC, or sarcoma

Indications for urethrectomy include the following:

  • Tumor in the anterior urethra

  • Prostatic stromal invasion that is noncontiguous with the primary

  • Positive urethral margin during radical cystectomy

  • Diffuse CIS of bladder, prostatic ducts, or prostatic urethra (a relative indication)

Rarely, radical cystoprostatectomy is indicated for salvage treatment for recurrent prostate cancer or intractable hematuria following primary therapy with radiation.

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