Radiochemotherapy in locally invasive non-metastatic carcinoma of the bladder.

We therefore believe that our therapeutic concept is a true alternative to primary cystectomy, with comparable survival rates. We observed a high rate of functional organ preservation in long-term survivors (79% with complete remission (CR) after 5 years). Radiation bladders were rare at doses not exceeding 60 Gy. Age and co-morbidity were not exclusion criteria. Presence of a competent and cooperative radiotherapy department is a precondition to preventing akinetic radiation bladders. Continuous life-long follow-up is necessary. Cystectomy, together with modern urinary diversions, is still necessary; it is performed in non-responders and in patients with muscle-invasive recurrences.

Evaluation of bladder dysfunction.

A careful and detailed history and physical examination can give clues to a neurogenic bladder disturbance. Urine analysis should always be performed to exclude urinary tract infection. The most important basic investigation is ultrasound of the kidneys and of residual urine. If these investigations reveal suspicion of a dysfunction, elaborate urological investigation, including cystoscopy and urodynamic studies, is necessary for classification and appropriate therapy of a neurogeneous vesicourethral disorder.