Both problems have now been attacked and the various alternatives have to be discussed with a urologist. For instance, newer pouches (Kock, Indiana, Camay, Mainz, etc.) have a large internal reservoir and a small external opening (nipple) that requires self-catheterization to remove urine only two or three times a day. This is much more appealing cosmetically because the external nipple can be left uncovered or be covered with an adhesive bandage. In some cases in males, a "neopouch" can be used—an attachment of a piece of bowel directly to the urethra—requiring no external pouch or catheterization at all. The neopouch cannot be used in females because of their short urethra.
Sexual function in males can also be improved by penile implants or by medication injected into the penis or inserted into the urethra before sex.
Radiation External radiation can be used for more advanced stages of bladder cancer. Overall, the
five-year survival rate for muscle invasive disease with surgery is 30 to 40 percent; for radical external radiation therapy , 20 to 30 percent.
Chemotherapy When superficial tumors constantly recur, intravesical treatment is tried. This
therapy permits direct contact of high concentrations of cytotoxic or immunologic drugs in the bladder, which bathe the superficial cancer cells for one or two hours. People with renal pelvis, ureteral and urethral cancers are not good candidates for intravesical therapy, although some reports now have described success.
