World Journal of Urology

, Volume 37, Issue 1, pp 61–83 | Cite as

SIU–ICUD consultation on bladder cancer: treatment of muscle-invasive bladder cancer

  • Jeffrey J. Leow
  • Jens Bedke
  • Karim Chamie
  • Justin W. Collins
  • Siamak Daneshmand
  • Petros Grivas
  • Axel Heidenreich
  • Edward M. Messing
  • Trevor J. Royce
  • Alexander I. Sankin
  • Mark P. Schoenberg
  • William U. Shipley
  • Arnauld Villers
  • Jason A. EfstathiouEmail author
  • Joaquim BellmuntEmail author
  • Arnulf StenzlEmail author
Topic Paper



To provide a comprehensive overview and update of the Joint Société Internationale d’Urologie–International Consultation on Urological Diseases (SIU–ICUD) Consultation on Bladder Cancer for muscle-invasive presumably node-negative bladder cancer (MIBC).


Contemporary literature was analyzed for the latest evidence in treatment options, outcomes, including radical surgery, neoadjuvant and adjuvant treatment modalities, and bladder-sparing approaches. An international multi-disciplinary expert panel evaluated and graded the data according to guidelines from the Oxford Centre for Evidence-Based Medicine.


Radical cystectomy (RC) is the standard of care for MIBC patients considered to be surgical candidates. While associated with substantial morbidity and mortality, this has been mitigated with improved technique, minimally invasive technology, and better perioperative care pathways (e.g., enhanced recovery after surgery). Neoadjuvant (NA) cisplatin-based combination chemotherapy improves overall survival and should be offered to eligible ≥ cT2N0 patients. Adjuvant (Adj) cisplatin-based combination chemotherapy may be considered, particularly for pT3–4 and/or pN+ disease without prior NA chemotherapy. Trimodal bladder-preserving treatment via maximum transurethral resection of bladder tumor followed by concurrent chemoradiation is safe and, when combined with early salvage RC for recurrence, offers long-term survival rates in selected patients comparable to RC. Immunotherapy is still experimental and is given either alone or in combination with chemotherapy and/or radiation.


A multi-disciplinary approach is paramount to achieving optimal outcomes for MIBC patients, irrespective of their age, performance and nutritional status, fitness/frailty, renal and other organ function, or disease severity.


Muscle-invasive bladder cancer Urothelial carcinoma of bladder Radical cystectomy Transurethral resection of bladder tumor Neoadjuvant chemotherapy Adjuvant chemotherapy Chemoradiation Trimodal Bladder-sparing Variant histology Enhanced recovery after surgery 


Author contributions

JJL: project development, data analysis, manuscript writing and editing; JB: data analysis and manuscript editing; KC: data analysis and manuscript editing; JWC: data analysis and manuscript editing; SD: data analysis and manuscript editing; PG: data analysis and manuscript editing; AH: data analysis and manuscript editing; EMM: data analysis and manuscript editing; TJR: data analysis and manuscript editing; AIS: data analysis and manuscript editing; MPS: data analysis and manuscript editing; WUS: data analysis and manuscript editing; AV: data analysis and manuscript editing; JAE: project development, data analysis, manuscript writing and editing; JB: project development, data analysis, manuscript writing and editing; AS: project development, data analysis, manuscript writing and editing.


No funding was obtained for this study.

Compliance with ethical standards

Conflict of interest

The authors declare no directly related conflicts of interest.

Ethical approval

The study was conducted according to the Declaration of Helsinki.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Jeffrey J. Leow
    • 1
  • Jens Bedke
    • 2
  • Karim Chamie
    • 3
  • Justin W. Collins
    • 4
    • 5
  • Siamak Daneshmand
    • 6
  • Petros Grivas
    • 7
  • Axel Heidenreich
    • 8
  • Edward M. Messing
    • 9
  • Trevor J. Royce
    • 10
  • Alexander I. Sankin
    • 11
  • Mark P. Schoenberg
    • 11
  • William U. Shipley
    • 12
  • Arnauld Villers
    • 13
  • Jason A. Efstathiou
    • 12
    Email author
  • Joaquim Bellmunt
    • 14
    Email author
  • Arnulf Stenzl
    • 2
    Email author
  1. 1.Department of UrologyTan Tock Seng HospitalSingaporeSingapore
  2. 2.Department of UrologyUniversity of TübingenTübingenGermany
  3. 3.Department of Urology and Institute of Urologic OncologyDavid Geffen School of Medicine at University of CaliforniaLos AngelesUSA
  4. 4.Department of Molecular Medicine and Surgery (MMK)Karolinska InstitutetSolnaSweden
  5. 5.Orsi AcademyMelleBelgium
  6. 6.USC Institute of Urology, University of Southern CaliforniaLos AngelesUSA
  7. 7.Division of Oncology, Department of MedicineUniversity of WashingtonSeattleUSA
  8. 8.Department of UrologyUniversity Hospital of CologneCologneGermany
  9. 9.Department of UrologyUniversity of Rochester Medical Center, University of Rochester School of Medicine and DentistryRochesterUSA
  10. 10.Department of Radiation OncologyUniversity of North Carolina at Chapel Hill School of MedicineChapel HillUSA
  11. 11.Department of UrologyMontefiore Medical Center, Albert Einstein College of MedicineBronxUSA
  12. 12.Genitourinary Division, Department of Radiation OncologyMassachusetts General Hospital, Harvard Medical SchoolBostonUSA
  13. 13.Department of UrologyUniversity of Lille Nord de FranceLilleFrance
  14. 14.PSMAR-IMIM Hospital del Mar Medical Research InstituteBarcelonaSpain

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