[Perioperative therapy for muscle-invasive bladder cancer-current treatment concepts].

The updated version of the German S3 guideline for bladder cancer introduces several changes in the areas of diagnostics, perioperative systemic therapy, and rehabilitation, as well as psycho-oncological and palliative care for bladder cancer patients. In urinary diagnostics, the Paris system, including a quality algorithm, has been introduced to improve the comparability of cytological findings. Imaging diagnostics now recommends multiparametric magnetic resonance imaging (MRI) with Vesical Imaging-Reporting and Data System (VI-RADS) reporting as an alternative or complement to computed tomography (CT) scans. CT urography remains the gold standard for the upper urinary tract, while intravenous pyelography (IVP) is no longer recommended. In perioperative systemic therapy, the importance of multidisciplinary case conferences for muscle-invasive bladder cancer (MIBC) is emphasized to enable as many patients as possible to receive perioperative systemic therapy. Rehabilitation now follows quality criteria (multiprofessional teams, long-term concepts) and includes an expanded assessment of physical and psychological burdens. Particularly relevant is the treatment of sexual dysfunction in women after cystectomy. In psycho-oncology and palliative medicine, early integration of the S3 guidelines is required, including advanced care planning (ACP) starting from the diagnosis of advanced tumors. These changes aim for higher diagnostic accuracy, better treatment planning, and holistic patient care.