Clinical outcome of conservative therapy with transurethral resection for patients with invasive bladder cancer who cannot tolerate cystectomy.

Among patients with invasive bladder cancer, there are patients who cannot tolerate cystectomy due to high age or comorbidities. We retrospectively reviewed 27 patients who were treated conservatively with transurethral resection (TUR). All patients had undergone TUR and 5 patients had received subsequent pelvic radiation therapy. The survival and control of local symptoms were analyzed statistically. Sixteen patients died of bladder cancer and 4 died of other causes with a median survival of 10 months. Seven patients were alive at a median follow up of 36 months. Tumor stage, grade and hydronephrosis at diagnosis were related with survival. Hematuria, bladder tamponade, and lower urinary tract obstruction could be controlled with TUR. However, those patients who complained of bladder irritative symptoms at diagnosis were likely to develop uncontrollable bladder irritability. Conservative treatment with TUR alone was an acceptable option in terms of survival for stage II patients with a short life expectancy. Even at more advanced stages, most of the local symptoms could be controlled with TUR. However, in patients with bladder irritability at diagnosis, the merit of cystectomy may outweigh its risk even among high age patients or those with severe comorbidities.