 T1 tumors at high risk of progression (high grade, multifocality, CIS, and tumor size, )  In all T1 patients failing intravesical therapy  muscle-invasive bladder cancer T2-T4a, N0-Nx, M0  BCG-resistant Tis  extensive papillary disease

 performance status and age influence the choice of primary therapy, as well as type of urinary diversion with cystectomy being reserved for younger patients without concomitant disease and better performance status

delay of treatment beyond 90 days of primary diagnosis caused a significant increase in extravesical disease (81 vs 52%)

Before cystectomy, the patient should be counselled adequately regarding all possible alternatives, and the final decision should be based on a consensus between patient and surgeon.

 prostate and seminal  urothelial cancer in the prostate was detected in 33%  in23-54% of patients a prostate cancer is found  uterus and adnexa in women  spare seminal vesicles and the prostatic capsule

 provides insight into the local extent  In limited nodal burden increase survival

There is a substantial amount of literature about the extent of lymphadenectomy. Yet, data regarding its clinical significance are controversial In retrospective studies extended lymphadenectomy (removal of the obturator, internal, external, common iliac and presacral nodes as well as nodes at the aortic bifurcation) has been reported to improve survival

 genitofemoral nerve laterally  internal iliac artery medially  Cooper ligament caudally,  and the crossing of the ureter at the common iliac artery cranially

 It is simplest type of conduit diversion to perform and isassociated with the fewest intraoperative and immediatepostoperative complications

 transverse colon is used when one wants to be surethat the segment of conduit employed has not been irradiated  sigmoid conduit is a good choice in patients undergoing a pelvic exenteration who will have a colostomy

Debilitating neurological and psychiatric illnesses. Limited life expectancy. Impaired liver or renal function. Transitional cell carcinoma of the urethral margin or other surgical margins