Radical Cystectomy

Radical cystectomy is primarily indicated for the treatment of muscle-invasive bladder cancer (stages T2-T4a).¹ It is also recommended for high-risk non-muscle invasive bladder cancer that is unresponsive to intravesical therapy (such as BCG treatment), particularly in cases of high-grade T1 tumors or carcinoma in situ (CIS) that persist or recur after adequate treatment.²

Patient selection for radical cystectomy involves careful consideration of disease stage, overall health status, and patient preferences.³ The optimal treatment approach for non-metastatic muscle-invasive bladder cancer typically consists of neoadjuvant cisplatin-based chemotherapy followed by radical cystectomy with pelvic lymph node dissection.⁴ For select patients, trimodal therapy (maximal transurethral resection followed by chemoradiation) may be considered as an alternative bladder-preserving approach, though radical cystectomy remains an option for salvage therapy if this approach fails.⁵

The surgical procedure can be performed using open, laparoscopic, or robot-assisted techniques, though complication rates and morbidity remain significant regardless of approach.⁶ Following bladder removal, urinary diversion is necessary, with options including ileal conduit (most common), continent cutaneous pouch (such as Indiana pouch), or orthotopic neobladder reconstruction.⁷ Each diversion type has specific advantages and disadvantages, and selection depends on patient factors, disease characteristics, and surgeon experience.⁸

Post-operative care focuses on managing complications, which may include bleeding, infection, poor wound healing, bowel obstruction, and metabolic disturbances.⁹ Long-term follow-up is essential to monitor for cancer recurrence, assess renal function, and address quality of life concerns related to urinary diversion.¹⁰