ABSTRACT
ABSTRACT Background Standard management of muscle-invasive bladder cancer involves radical cystectomy with pelvic lymph node dissection. However, patients may be ineligible for surgery or may wish to avoid the morbidity of cystectomy due to quality of life concerns. Bladder preservation therapies have emerged as alternatives treatment options that can provide comparable oncologic outcomes while maintaining patients' quality of life. Objective To review bladder preservation therapies, patient selection criteria, and functional and oncologic outcomes for BPT in muscle-invasive bladder cancer. Materials and Methods We conducted a comprehensive literature review of bladder preservation therapies in Pubmed and Embase. Discussion The ideal patient for BPT has low-volume T2 disease, absence of CIS, absence of hydronephrosis, and a maximal TURBT with regular surveillance. Technological advancements involving cancer staging, TURBT technique, and chemotherapy and radiation therapy regimens have improved BPT outcomes, with oncologic outcomes now comparable to those of radical cystectomy. Advancements in BPT also includes a heightened focus on improving quality of life for patients undergoing bladder preservation. Preservation strategies with most evidence for use include trimodality therapy and partial cystectomy with pelvic lymph node dissection. Conclusions This review highlights the breadth of strategies that aim to preserve a patient's bladder while still optimizing local tumor control and overall survival. Future areas for innovation include the use of predictive biomarkers and implementation of immunotherapy, moving the field towards patient-tailored care.
Subject(s)
Humans , Urinary Bladder Neoplasms/surgery , Cystectomy/methods , Urinary Bladder Neoplasms/pathology , Combined Modality Therapy , Organ Sparing Treatments , Neoplasm Invasiveness , Neoplasm StagingABSTRACT
"Destiny guides our fortunes more favorably than we could have expected" wrote Miguel de Cervantes Saavedra, author of the legendary novel Don Quixote of La Mancha. These words describe exactly what has happened to us over the past year. We met by chance at a urology congress last August in the City of Barranquilla. We took the opportunity to sit down unsuspectingly with coffee in hand and started talking about the big picture of urology in the world and especially in Latin America. We soon realized that despite being born in two countries as different as the United States and Colombia, we both shared similar barriers as women urologists. The truth is that despite the increase in the number of women in careers such as medicine, the growth in terms of medical and surgical specialties is still very low. According to the latest census of the American Urological Association (AUA), female urologists currently make up only 9.9% of the total membership in the US academy.[1] What is contradictory is that many studies have evaluated the change in the workforce that has been occurring in this branch of medicine for a few years, since it is assumed that by 2060 there will be a growth in the number of women of 3.7% versus 1.3% compared to men.[2] These two surprising facts forced us to think about the need to find solutions.
"El destino guía nuestra suerte más favorablemente de lo que podíamos esperar", escribió Miguel de Cervantes Saavedra, autor de la legendaria novela Don Quijote de la Mancha. Estas palabras describen exactamente lo que nos ha ocurrido en el último año. Nos conocimos por casualidad en un congreso de urología el pasado mes de agosto en la ciudad de Barranquilla. Aprovechamos la oportunidad para sentarnos desprevenidamente con un café en la mano y empezamos a hablar sobre el gran panorama de la urología en el mundo y especialmente en Latinoamérica. Pronto nos dimos cuenta que a pesar de haber nacido en dos países tan diferentes como Estados Unidos y Colombia, ambas compartíamos barreras similares como mujeres urólogas. Lo cierto es que a pesar del aumento del número de mujeres en carreras como medicina, el crecimiento en cuanto a especialidades médicas y quirúrgicas es aún muy bajo. Según el último censo de la Asociación Americana de Urología (AUA), en la actualidad las mujeres urólogas representan sólo el 9,9% del total de miembros de la academia estadounidense[1] Lo contradictorio es que muchos estudios han evaluado el cambio en la fuerza laboral que se viene dando en esta rama de la medicina desde hace algunos años, pues se presume que para el año 2060 habrá un crecimiento en el número de mujeres del 3,7% frente al 1,3% de los hombres[2] Estos dos sorprendentes datos nos obligaron a pensar en la necesidad de encontrar soluciones.