Pan Gao,1,* Xinyu Li,1,* Ziqiu He,1 Yifan Xu,2 Zhi Zhang1 

1Department of Urology, Second People’s Hospital of Yichang, Second People’s Hospital of China Three Gorges University, Yichang, Hubei Province, People’s Republic of China; 2Department of Pathology, Second People’s Hospital of Yichang, Second People’s Hospital of China Three Gorges University, Yichang, Hubei Province, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Zhi Zhang, Department of Urology, Second People’s Hospital of Yichang, Second People’s Hospital of China Three Gorges University, 21 Xiling One Road, Yichang, Hubei Province, 443000, People’s Republic of China, Email 702032715@qq.com

Abstract: Primary bladder large cell neuroendocrine carcinoma (LCNEC) is a rare, aggressive neoplasm with high recurrence rates and poor prognosis. Traditional management has heavily relied on radical cystectomy, which, despite its aggressiveness, often results in unsatisfactory outcomes. Emerging evidence suggests the potential for less invasive, bladder-sparing approaches, yet detailed reports and long-term outcomes remain scarce. We report a groundbreaking case of a 59-year-old male diagnosed with primary bladder LCNEC, managed through a pioneering bladder-sparing multimodal treatment. This novel strategy included transurethral resection followed by a tailored chemoradiation protocol, resulting in exceptional disease control and preservation of bladder function over a 20-month follow-up period, without evidence of recurrence. This case underscores the viability of bladder conservation strategies as a legitimate alternative to radical cystectomy for managing LCNEC, presenting a beacon of hope for patients wishing to preserve bladder functionality. It prompts a reevaluation of traditional treatment paradigms and advocates for further research into multimodal, organ-sparing approaches for this challenging malignancy.

Keywords: LCNEC, bladder conservation, TURBT, secondary transurethral resection, EP regimen, radiotherapy