Radical cystectomy for carcinoma of the bladder: 16 years of experience.

The records of 141 consecutive patients who underwent simple or radical cystectomy between 1955 and 1971 were reviewed. Symptoms, interval before diagnosis, and stage and grade of lesion were analyzed and correlated with survival rates. Although stage was the most critical determinant of survival, grade, presence or absence of dysuria and delay in diagnosis were also important. Preoperative radiotherapy caused downstaging in 41.2 per cent of patients, with complete disappearance of tumor in some. Postoperative complications from cystectomy and from various forms of urinary diversion were correlated with the type of diversion, type of ureteral anastomosis, radiotherapy and stents. Improved operative techniques, method of fluid balance, and preoperative and postoperative care have led to a progressively decreased operative mortality in patients with carcinoma of the bladder.