Bladder Cancer · TURBT vs Radical Cystectomy

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

🎓 Want to practice? Do a case challenge with this pathway → (get a case, choose management step by step, scored).

Full pathway

1. [Decision] Stage (NMIBC vs MIBC) + risk
   Muscle-invasive? Risk? Operable?
   • Non-muscle-invasive NMIBC (Ta/T1/CIS) → NMIBC → TURBT + instillation
   • Muscle-invasive MIBC (≥T2), operable → MIBC → neoadjuvant + radical cystectomy
   • MIBC unfit for surgery/wants bladder preservation → Trimodality bladder preservation
   • Metastatic/extensive → Metastatic → systemic therapy
2. [End] NMIBC → TURBT + instillation
   NMIBC → complete TURBT (re-TURBT for high-risk/T1) + intravesical instillation (BCG for high-risk, immediate mitomycin for low-risk); high-risk/BCG failure → consider early radical cystectomy.
3. [End] MIBC → neoadjuvant + radical cystectomy
   MIBC (≥T2) → neoadjuvant cisplatin-based chemotherapy + radical cystectomy + urinary diversion (ileal conduit/orthotopic neobladder) + pelvic lymph node dissection.
4. [End] Trimodality bladder preservation
   Unfit for surgery or wants bladder preservation → trimodality therapy (maximal TURBT + chemoradiation), with strict cystoscopic surveillance; recurrence/failure → salvage cystectomy.
5. [End] Metastatic → systemic therapy
   Metastatic → systemic therapy (platinum-based chemotherapy, immune checkpoint inhibitors, antibody-drug conjugates such as enfortumab vedotin); mainly palliative.

Source guidelines & references

• Bladder cancer management (AUA/SUO NMIBC; MIBC guidelines; EAU)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

Other pathways