Management dilemmas in bladder cancer: radical TUR +/- systemic chemotherapy in the treatment of muscle-invasive bladder cancer.

This case report follows the course of a highly aggressive bladder cancer that presented with carcinoma in situ and illustrates the rapid rate of progression from superficial to invasive disease that may be observed in some individuals. This case also highlights concerns about alternative management options and the dilemmas that arise when cystectomy is delayed by failed conservative strategies attempting to preserve the native bladder. This discussion focuses on the combination of radical transurethral resection (TUR) and systemic chemotherapy as a therapeutic alternative to cystectomy. The concept, technique, indications, and contraindications of radical TUR, and the rationale for combination systemic chemotherapy are discussed with reference to this case. We consider the value of radical TUR and systemic chemotherapy as an alternative to cystectomy and the reasons why this patient would not have been a suitable candidate for this bladder-sparing approach.