Vol. 6, Issue 1, Part A (2024)

Muscle-invasive transitional cell carcinoma (TCC) of the bladder poses a considerable therapeutic challenge, traditionally managed by radical cystectomy. However, bladder preservation protocols have gained prominence as feasible alternatives, aiming to maintain the patient's quality of life without compromising oncological outcomes. This comprehensive review delves into the current bladder preservation strategies, scrutinizing their efficacy, patient selection criteria, treatment modalities, and overall outcomes. We discuss the integration of multimodal approaches, including transurethral resection of the bladder tumor (TURBT), chemotherapy, and radiotherapy, highlighting their synergistic potential in achieving local control and long-term survival. The review examines the criteria for patient selection, emphasizing the importance of tumor staging, patient comorbidities, and bladder function in determining the suitability for bladder-preserving strategies. We explore the therapeutic impact and side effect profiles of various chemotherapeutic agents and radiation techniques, and the role of concurrent chemoradiotherapy in enhancing treatment efficacy. Furthermore, we investigate the emerging role of novel therapies and biomarkers in bladder preservation. Advances in immunotherapy, targeted therapies, and molecular markers hold promise for more personalized treatment approaches, potentially improving outcomes and reducing treatment-related toxicity. The integration of these novel therapies with traditional multimodal approaches is also discussed, providing insights into future directions in bladder preservation. Our analysis includes a critical evaluation of clinical trials and real-world studies, presenting evidence on survival rates, recurrence patterns, and quality of life metrics. The review aims to furnish an updated perspective on bladder preservation, offering guidance for clinical decision-making and highlighting areas where further research is needed. By optimizing bladder preservation protocols, we can enhance patient outcomes, achieving a balance between effective oncological control and preservation of bladder function.