Radical cystectomy for bladder cancer in Sub-Saharan Africa: techniques, challenges, and survival outcomes: a comprehensive review.

Abstract

Radical cystectomy (RC) with urinary diversion remains the gold-standard treatment for muscle-invasive bladder cancer (MIBC), yet its implementation in Sub-Saharan Africa is hindered by late-stage presentation, limited surgical expertise, and inadequate perioperative care. These challenges contribute to higher morbidity and poorer survival outcomes compared to high-income regions. Additionally, the high prevalence of schistosomiasis-associated squamous cell carcinoma, disparities in multidisciplinary cancer care, and the burden of comorbidities further complicate treatment.This review examines RC techniques practiced in Africa, from open to minimally invasive approaches, assessing their feasibility within resource-limited settings. It explores challenges specific to the region, highlighting the impact of infrastructure gaps, limited access to neoadjuvant and adjuvant therapies, and variations in surgical training. Addressing these barriers requires urgent investment in oncology infrastructure, expanded access to multimodal therapy, and early detection strategies. Optimizing perioperative management and promoting cost-effective urinary diversion techniques are critical to improving bladder cancer outcomes in the region.