Preservation of the bladder, but at what cost?

Radical cystectomy (rCx) with pelvic lymphadenectomy is the gold standard for muscle invasive bladder cancer. Nevertheless advantages of trimodal treatment (TMT) over rCx is an ongoing discussion in urology. According to the guidelines of the European Association of Urology and the SIU, TMT should only be offered to “selected, well-informed, compliant” patients (1,2). Due to a lack of randomized studies comparing the two, we can only rely on retrospective analysis. Most of these focus on the functional and oncological outcome. With aging populations in most industrialized countries and therefore rising healthcare expenses, cost effectiveness is of growing importance. This is reflected in a trend in current publications to investigate the differences in cost of different treatments available. However, as stated in the article this does not mean cost-effectiveness, i.e., oncological outcome and quality of life.