New Strategies in the Treatment of Ta-T1 Transitional Cell Carcinoma (TCC) of the Bladder

In recent years, there have been many advances in the treatment of superficial bladder cancer. Standard intravesical chemotherapeutic agents can now be delivered more effectively thanks to new technological advances in drug delivery. Local microwave hyperthermia and electromotive drug administration are of particular interest. Research has also shown that different combinations of drugs and sequential drug delivery of two or more different drugs for differing periods of time also increase the effectiveness of possible treatments of superficial bladder cancer. Furthermore, new chemotherapeutic drugs for intravesical use are being investigated in various clinical trials, with gemcitabine showing particularly promising results. Also in the pipeline are new approaches to treatment such as gene therapy, but these will need to be developed much more before they become part of routine practice

Complications following radical cystectomy for bladder cancer in the elderly

CONTEXT: The incidence of bladder cancer increases with advancing age. Considering the increasing life expectancy and the increasing proportion of elderly people in the general population, radical cystectomy will be considered for a growing number of elderly patients who suffer from muscle-invasive or recurrent bladder cancer. OBJECTIVE: This article reviews contemporary complication and mortality rates after radical cystectomy in elderly patients and the relationship between age and short-term outcome after this procedure. EVIDENCE ACQUISITION: A literature review was performed using the PubMed database with combinations of the following keywords cystectomy, elderly, complications, and comorbidity. English-language articles published in the year 2000 or later were reviewed. Papers were included in this review if the authors investigated any relationship between age and complication rates with radical cystectomy for bladder cancer or if they reported complication rates stratified by age groups. EVIDENCE SYNTHESIS: Perioperative morbidity and mortality are increased and continence rates after orthotopic urinary diversion are impaired in elderly patients undergoing radical cystectomy. Complications are frequent in this population, particularly when an extended postoperative period (90 d instead of 30 d) is considered. CONCLUSIONS: Although age alone does not preclude radical cystectomy for muscle-invasive or recurrent bladder cancer or for certain types of urinary diversion, careful surveillance is required, even after the first 30 d after surgery. Excellent perioperative management may contribute to the prevention of morbidity and mortality of radical cystectomy, supplementary to the skills of the surgeon, and is probably a reason for the better perioperative results obtained in high-volume centers