Operative Therapie des Harnblasenkarzinoms: Fortschritte der letzten 50 Jahre

Abstract

The past 5 decades have seen major advances in the surgical treatment of bladder cancer, which have significantly reduced the morbidity and mortality of the disease. Enhanced understanding of tumour biology as well as a large number of newly developed endoscopic instruments and techniques have contributed to making treatment more successful. Moreover, modified and improved surgical techniques of radical cystectomy have been implemented and the clinical and pathological risk stratification of patients has been improved. Hence, patients are treated differently according to risk groups. Treatment algorithms range from repeated transurethral resections to adjuvant intravesical therapy to radical cystectomy, which may be part of a multimodal approach with curative intent. Celebrating the 50th anniversary of "Aktuelle Urologie", we summarise the most important advances in the treatment of BC since 1969 and report some current trends. Modern endoscopic imaging techniques ("enhanced cystoscopy") and molecular subtyping of BC may further improve risk stratification. Moreover, some initial experience has been made with robot-assisted radical cystectomy, and there are new trends for the standardisation of techniques, concepts of enhanced recovery after surgery, as well as initiatives for the measurement of surgical quality and patient-reported outcomes. We believe that all these current developments may help to further improve the quality of life and therapeutic outcome of patients with BC.