Cystectomy Alternatives: Non-Surgical and Organ-Preserving Options

For patients unsuitable for radical cystectomy (bladder removal), alternatives depend on cancer stage, health, and preference:

1. Active Surveillance – For very low-risk non-muscle-invasive disease; regular cystoscopy and imaging.
2. Intravesical Therapy – BCG or chemotherapy instilled directly into bladder for non-muscle-invasive cancer.
3. Partial Cystectomy – Removes only tumor-bearing portion; preserves bladder function.
4. Bladder Reconstruction/Urinary Diversion – Neobladder from bowel or continent diversion if bladder must be removed.
5. Radiation Therapy – External beam, often with chemotherapy (trimodal therapy).
6. Systemic Chemotherapy – For advanced/metastatic disease.
7. Immunotherapy – Checkpoint inhibitors for advanced urothelial carcinoma.

Multidisciplinary tumor board discussion individualizes the approach.