Bladder cancer (BCa) is the most common malignancy of the urinary tract and one of the most prevalent cancers worldwide. While the clinical approach to BCa has remained largely unchanged for many years, recent discoveries have paved the way to a new era of diagnosis and management of the disease. BCa-specific mortality started to decrease in the regions with a wide range of activities leading to greater social awareness of the risk factors and the decline in carcinogenic exposure. The urologic community refines the role of transurethral surgery towards more rigorous and high-quality techniques. New agents have been approved for patients with BCG failure who faced radical cystectomy so far. Although radical removal of the bladder is the gold standard for muscle invasive cancer management, the extent and clinical value of lymphadenectomy is currently heavily challenged in randomized trials. Furthermore, alternatives to perioperative chemotherapy have arisen to increase the likelihood of complete treatment delivery and successful oncological outcomes. Finally, improvements in molecular biology and our understanding of tumorigenesis open the era of personalized medicine in bladder cancer. In the present review, the status and future directions in bladder cancer epidemiology, diagnosis and management are thoroughly discussed.

The purpose of this review is to present the current status of lymph node dissection (LND) during radical cystectomy in patients with bladder cancer (BCa). Despite the growing body of evidence of LND utility at the time of radical cystectomy (RC) in high-risk nonmuscle-invasive and muscle-invasive BCa (MIBC), therapeutic and prognostic value and optimal extent of LND remain unsolved issues. Recently published results of the first prospective, a randomized trial assessing the therapeutic benefit of extended versus limited LND during RC, failed to demonstrate survival improvement with the extended template. Although LND is the most accurate staging procedure, the direct therapeutic effect is still not evident from the current literature, limiting the possibility of establishing clear recommendations. This indicates the need for robust and adequately powered clinical trials.

Background/Objectives: Routine local gentamicin irrigation has been used during artificial urinary sphincter (AUS) implantation despite limited procedure-specific evidence. We evaluated early outcomes after its calendar-defined discontinuation. Methods: This single-centre retrospective before–after cohort included 173 uncoated AMS 800 procedures in 164 men: 59 under a gentamicin-containing local protocol and 114 after gentamicin withdrawal. Saline device immersion and Betadine-containing intraoperative irrigation of the operative field and both wounds continued in both periods. Clinician-recorded surgical-site infection (SSI) within 90 days was the antimicrobial outcome of greatest direct relevance. Complete explantation within 90 days for SSI and/or urethral erosion was an exploratory device-related endpoint; all-cause complications at 30 and 90 days were secondary safety outcomes. Results: SSI occurred after 1/59 (1.7%) gentamicin-protocol and 2/114 (1.8%) gentamicin-free procedures (risk difference +0.1 percentage points, 95% confidence interval −7.4 to +4.7; p = 1.000). Erosion occurred after 0/59 and 4/114 (3.5%) procedures; all four led to complete explantation. The explantation endpoint occurred after 1/59 versus 4/114 procedures (risk difference +1.8 percentage points, 95% confidence interval −5.8 to +7.2; p = 0.662). Thirty-day all-cause complications occurred after 14/59 versus 16/114 procedures and 90-day complications after 15/59 versus 26/114. Conclusions: No statistically significant between-period difference was detected in SSI, exploratory device-related explantation, or broad all-cause complications. Sparse events, wide confidence intervals and calendar-defined exposure amid concurrent era changes preclude conclusions regarding equivalence or absence of clinically relevant benefit or harm.