Challenging dilemmas of low grade, non-invasive bladder cancer: a narrative review.

To describe the current scientific knowledge and clinical experience in low-grade-non-muscle-invasive bladder cancer (LG-NMIBC) patients in challenging scenarios.

Medline, Embase, Google Scholar, and Cochrane Central were searched until March 2021.

A total of 841 studies were identified, and abstracts were analyzed. Twenty-one relevant studies were then identified and reviewed. After all, information was gathered from 16 studies, the authors discussed the specific topics, and expert opinions were also included in the discussion. There have been some studies that can help us to have some insights on how to manage these patients. Very distinctive strategies have been reported in the literature, mainly anecdotally or in small randomized studies. Some of these treatments outlined in the present manuscript include repeated TURBTs, chemoablation, BCG immunoablation, partial cystectomy, radical cystectomy, radiotherapy, chemotherapy, and future perspectives. In the current manuscript, we have combined these strategies in a proposed algorithm.

For those LG-NMIBC patients in challenging scenarios, we have found repeated TURBTs, chemoablation, BCG immunoablation, partial cystectomy, radical cystectomy, radiotherapy, and chemotherapy are attractive modalities to treat them effectively. Also, the current manuscript proposes an algorithm to overcome these challenges.

International braz j urol : official journal of the Brazilian Society of Urology. 2021 Jun 20 [Epub ahead of print]

Fernando Korkes, Phillipe E Spiess, Herney Andres Garcia-Perdomo, Andrea Necchi

Disciplina de Urologia, Faculdade de Medicina do ABC - FMABC, Santo Andre, SP, Brasil., Department of Genito-Urinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, EUA., Division of Urology / Urooncology, Department of Surgery, School of Medicine, Research Group - UROGIV, Universidad Del Valle, Cali, ColĂ´mbia., Discipline of Urology, University Vita-Salute San Raffaele, Milan, Italy.

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