The role of surgical treatment of infiltrating tumors will be affected by two factors: (1) the depth of infiltration22 and (2) the extent of surface spread. Although it may well be that they represent merely the two extremes of the same disease, it is necessary, for practical purposes, to consider them as two separate forms of neoplasia—the single, infiltrating, localized lesion with which the problem may be one of lymphatic spread, or the lesion associated with widespread mucosal changes in the bladder, prostatic ducts, urethra, renal pelvis, or ureter.
Localized but infiltrating lesions can be treated by endoscopic resection, by open resection with or without supplementary radioactive implant, by segmental resection, and by radical cystectomy.
The Endoscopic Approach
The endoscopic approach depends for its success on the capability and experience of the surgeon. There are few resectionists capable of completely resecting a tumor more than 6 cm in diameter,