Changing attitudes to the management of muscle invasive bladder cancer—A postal survey of UK urologists

Summary 

Introduction

In the United Kingdom, radiotherapy as opposed to cystectomy has been the preferred treatment modality in invasive bladder cancer [Bower M, Ma R, Savage P, Abel P, Waxman J. British urological surgery practice. 2. Renal, bladder and testis cancer. BJU 1998;81:513–7]. However, there appears to have been a recent shift from this approach in favour of radical cystectomy. Against this background, we conducted to postal survey of all full UK urologists to ascertain their practice.

The aim of the study was to find out about the current practice of management of muscle invasive bladder cancer in the UK, in particular the shift from radiotherapy to radical surgery as the preferred method of treatment.

Material and methods

A 19-point questionnaire on management of muscle invasive bladder cancer was posted to all UK based full BAUS members.

Results

478 questionnaires were sent and 139 valid responses received. Ninety percent used CT as the staging investigation; only 43% requested a bone scan. Eighty two percent offered radical cystectomy as the treatment of choice, of these 94% also undertook limited or extended pelvic node dissection. Five percent used neo-adjuvant radiotherapy. Sixty nine percent routinely undertook an ileal conduit diversion; 31% discussed other forms of diversion and only 6% undertook orthotopic bladder reconstruction routinely. Recurrence after radiotherapy was treated by salvage cystectomy by 87%. The majority of respondents offered life-long follow-up.

Conclusion

Radical cystectomy is the favoured treatment of UK urologists for muscle invasive bladder cancer. Ileal conduit is still the preferred method of diversion and only a small minority offer orthotopic reconstruction.

Perhaps better patient education as well as better reconstructive training opportunities for cancer urologists will make neobladders a favoured option in the future.

Keywords: Muscle invasive bladder cancer, Cystectomy, Radiotherapy