A 68-year-old man with bladder cancer undergoes TURBT; pathology shows T2 high-grade urothelial carcinoma. After neoadjuvant cisplatin-based chemotherapy, which surgical procedure is the gold standard?
- A Radical cystectomy with orthotopic neobladder construction
- B Repeat TURBT with intravesical BCG
- C Radical cystectomy (with any urinary diversion) ✓
- D External beam radiotherapy alone
Correct answer: C. Radical cystectomy (with any urinary diversion)
Explanation
Radical cystectomy (cystoprostatectomy in men, anterior exenteration in women) is the gold standard for muscle-invasive bladder cancer; the choice of diversion (ileal conduit, orthotopic neobladder, cutaneous ureterostomy) depends on patient factors and surgeon preference — orthotopic neobladder is preferred when the urethra is oncologically safe and the patient is fit. Neoadjuvant cisplatin-based chemotherapy (ddMVAC or GC) provides a 5% absolute survival benefit and precedes surgery.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.