For patients with T1 bladder cancer who have severe obstructive uropathy/hydronephrosis, do you treat as high risk stage I disease with RC, or clinically upstage and manage as a more locally advanced disease (NAC+RC)?   

Clinical staging of bladder cancers with cystoscopy and imaging is associated with significant upstaging at immediate surgery nearly 25% of the time. Hydronephrosis is typically viewed as a T3 disease barring some other clear-cut cause high in the ureter such as a stone. Therefore, I prefer to have ...