As nicely stated in this editorial comment, multimodal bladder-sparing chemo-radiotherapy offers the potential of similar recurrence-free survival outcomes when offered to a well-selected patient subset as compared with the gold standard of radical cystectomy and extended lymph node dissection as demonstrated in a number of contemporary prospective and long-term studies. ' There are several important therapeutic considerations when evaluating a patient's suitability for a bladder-sparing approach as a definitive treatment option for muscle-invasive urothelial carcinoma of the bladder including insuring: (1) the absence of clinical stage T3 or T4 disease, (2) the absence of preoperative hydronephrosis and/or carcinoma in situ, and (3) completing a maximal transurethral resection before chemo-radiotherapy to eradicate all visible cystoscopic diseases before embarking on this treatment approach. One of the greatest benefits of irltravesical lipiodoi injection pertains to its ability to accurately target radiotherapy to the primary organ site, which we describe in detail in the present techniques article.
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