الفهرس 
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Abstract
Bladder cancer is the 10th most common cancer worldwide. In Egypt, BC was the 2nd most common cancer in males & the 3rd in both sexes. MIBC constitutes about 30% of newly diagnosed cases and about 20-30% of non-invasive BC cases progress to invasive cancer after TURBT. Radical cystectomy (RC) with pelvic lymphadenectomy and urinary diversion is the gold standard for MIBC. Bladder cancer survivors following RC have a significant impact on their QOL with genitourinary or sexual dysfunction thus BST strategy is becoming an attractive alternative to cystectomy for fit patients aimed at bladder preservation. There are no completed RCT comparing the outcome of BST with RC. This is a prospective RCT that included patients with non metastatic MIBC. The enrolled patients were randomized into 2 groups (group A underwent maximal TURBT followed by CCRT while group B received NAC followed by RC). There was no statistically significant difference between both groups as regard OS and PFS. RR was comparable between both groups with statistically significant difference between RR in patients with N0 and N1 disease at presentation in group A. In multivariate analysis for factors affecting survival, it was found that DM and T stage at presentation were affecting PFS while chemotherapy type used was significant predictor for OS. In both groups treatment was tolerable, most of complications were G1 and G2 toxicities. In conclusion, BST is an emerging procedure with tolerable toxicities and similar oncologic outcomes to cystectomy for patients with MIBC. In selected patients, TMT should be considered as an alternative option to RC and in patients who are unable or unwilling to pursue cystectomy. Before RC, platinum based NAC should be the mainstay of treatment, gemcitabine – cisplatin is well tolerated regimen with promising outcomes. There were many limitations for the trial, being small number of patients with short follow up period. Multicentric larger randomized controlled trials with long-term follow up are warranted to define best candidates, regimen for TMT and RC.