Surgery for Bladder and Upper Tract Urothelial Cancer

Bladder cancer remains very common and associated with a high mortality. Surgery begins with TURBT to reach an accurate diagnosis and staging of disease. Advances such as blue-light cystoscopy and NBI have the potential to reduce recurrence rates following TURBT. RC remains the gold standard for MIBC. It provides excellent local control and good long-term outcomes; however, it is associated with significant perioperative morbidity. The use of minimally invasive approaches such as robotic surgery and adoption of ERAS protocols have helped reduce the early morbidity. Late complications are predominantly related to the UD performed, and patient counseling preoperatively is key. LDN is an essential component of the procedure, but its extent remains debated. UTUC is a rare disease and can occur before or after bladder carcinoma caused by a field urothelial change. Diagnostic URS is needed if doubt exists following cytology and imaging. Low-risk tumors can be managed by conservative approaches such as ureteroscopy, percutaneous approaches, conservative surgery, and chemoablation without compromising oncologic outcomes; however, strict follow-up is essential. High-risk UTUC necessitates RNU with template LDN and bladder cuff excision. This procedure is now predominantly done using a minimally invasive approach. In patients with solitary kidneys or bilateral disease, decisions for conservative procedures need to be taken on an individual basis after accounting for tumor-related and patient related factors.