Editing CUA: Muscle-invasive Bladder Cancer (2019) (section)

=== Radical cystectomy ===
* '''The standard therapy for localized MIBC is radical cystectomy'''
* '''Timing of cystectomy'''
** '''Cystectomy should be done 4-6 weeks (at most 10 weeks) after completion of NAC''' to avoid compromising survival
** '''The optimal timing of radical cystectomy where NAC has not been administered is within 6 weeks of TURBT'''
* Patients scheduled for radical cystectomy are recommended to receive perioperative optimization according to endorsed Enhanced Recovery after Abdominal Surgery (ERAS) protocols.
* '''Orthotopic urinary diversion should be offered to all eligible patients as an alternative to an ileal conduit.'''
** '''An intraoperative frozen section evaluation of the urethral margin should be performed prior to creating an orthotopic diversion.'''
* '''Urethrectomy should be performed in/contraindications to orthotopic neobladder (4):'''
*# '''Positive urethral margin'''
*# '''Men with:'''
*## '''High grade or invasive urethral disease distal to the prostatic urethra'''
*## '''Suspected prostatic stromal involvement'''
*# '''Women with bladder neck tumours'''
* Cystectomy pathology
** The final pathology report should contain information on: histology (including variants), stage, grade, presence of concomitant CIS, presence of LVI, number of lymph nodes, number of positive lymph nodes, and surgical margin status
** Assessment of accompanying reproductive organs (prostate, uterus, cervix, ovaries, vagina) should be performed to rule out occult secondary malignancy and for determination of final pathologic stage