Hi T,
This is a difficult one. If he cannot be complient with the demands of a diversion he will have to have someone who will come in and take care of him every day. The simpliest diversion is the ileal conduit but it has to be changed and cared for. I would not let them do a neobladder on him or an Indiana Pouch as he would have to train them and if they do not work properly which is often the case he will have leakage or backup into the kidneys (which also can happen with the ileal conduit) and he will have to catherize himself. I can assure you that noone will be able to do that or will want to do it unless they're
a stoma nurse and they are far and few between as well as expensive. He will get some weeks of at home care but if he cannot learn how to take care of the area and change it himself he will need someone who can do it for him.
I don't know where you are located but i would suggest you contact Dr. Mark Shoenberg of Johns Hopkins for some advise. Sometimes with an older patient who cannot be complient with a diversion...even with muscle invasive they go in and completely re-Turb it and remove all margins. They have to be continually monitored..every 3 months..but there have been cases of even a T2a regressing to a lower stage. This is still only being done at a few MAJOR cancer centers and by Top surgeons. I don't think a local uro would have the skill to do it truthfully.
You'll notice Dr. Schoenberg has an email address
urology.jhu.edu/markschoenberg/index.php
I think chemo and radiation would just make his life unbearable.
And cystectomy is not an easy operation. Being in great prior health it takes at least 6 to 8 weeks to start feeling better and he would probably have to be put in a rehab center for that period of time.
I wish you the best.
Pat