Michael S. Cookson, MD, MMHC, presented “Muscle Invasive Bladder Cancer: 2018 Guidelines” during the 27th Annual Perspectives in Urology: Point Counterpoint on November 9, 2018 in Scottsdale, Arizona.

How to cite: Cookson, Michael S. “Muscle Invasive Bladder Cancer: 2018 Guidelines” November 9, 2018. Accessed Jul 2022. https://grandroundsinurology.com/muscle-invasive-bladder-cancer-2018-guidelines/

Muscle Invasive Bladder Cancer: 2018 Guidelines – Summary:

Michael S. Cookson, MD, MMHC, outlines the purpose, methodology, and background for recently released guidelines for treating muscle invasive bladder cancer, including cisplatin-based chemotherapy. He highlights recommendation statements regarding patient counseling, neoadjuvant/adjuvant chemotherapy, radical cystectomy, pelvic lymphadenectomies, and more.


In 2018, the American Urology Association, along with a panel of organizations, created thirty-five guidelines for the treatment of muscle invasive bladder cancer (MIBC), based on randomized controlled trials (RCTs), high-level evidence, clinical principles, and expert opinions.

To note a few of the most important guidelines, the panel recommends offering cisplatin-based, and not carboplatin-based, chemotherapy prior to radical cystectomy (RC). Clinicians should complete the RC as soon as possible (6-8 weeks after chemotherapy). In most cases, this should not be a partial cystectomy. The guidelines also cover decision-making for bladder and organ preservation. Regarding perioperative management, the guidelines highlight Enhanced Recovery After Surgery (ERAS) principles, thromboembolic prophylaxis, opioid antagonist therapy, and counseling patients on urinary diversion care.

Also, the panel strongly recommends performing pelvic lymphadenectomies to help with curative intent, removing at least the external and internal iliac and obturator lymph nodes. For patients that choose a multi-modal bladder preserving therapy, they should undergo a maximal transurethral resection (TUR) of bladder tumor. Furthermore, patients with MIBC should not have radiation therapy as stand-alone treatment.

Additionally, the panel recommends counseling patients on how treatment will affect their quality of life. While clinicians may want to downplay this, it is critical to be upfront about life-altering side effects. Also, physicians should counsel patients about proper nutrition, smoking cessation, and other healthy lifestyle choices in the perioperative setting. Finally, follow-up should include chest imaging, cross sectional CT or MRI imaging of the abdomen and pelvis at 6-12 month intervals for the first 2-3 years, and then annually since most recurrences appear in the first two years.

About Perspectives in Urology: Point Counterpoint

Perspectives in Urology: Point Counterpoint (PCP) is an annual CME-accredited conference devoted to discussing and debating the latest topics in men’s health, general urology, and genitourinary cancers. The conference’s format includes more than didactic lectures. It also includes debates, point-counterpoint discussion panels, and unique case-based presentations. Dr. Cookson presented this lecture during the 27th PCP in 2018. Please visit this page in order to register for future PCP meetings.