Developments in preoperative staging of bladder tumors.

We have found that routine bilateral selective angiographic studies for patients considered candidates for radical cystectomy is a useful technique. Our experiences since 1968 to present have indicated that early bladder invasion and occult metastases can be detected at a rate exceeding that of clinical staging alone. Angiographic staging in D lesions, when supplemented by lymphangiogram, can approach 100 per cent accuracy. Our current false negative lymphangiogram rate is relatively low, that is, 1.9 per cent. The over-all angiographic and lymphangiographic staging accuracy prior to surgery in our most recent series of cystectomy patients was nearly 79 per cent. Such techniques and reliability of data are discussed in detail including the factors which interfere with the exact angiographic staging of bladder cancer. These techniques in no way are meant to surplant routine preoperative clinical evaluations which are appropriately used with additional accuracy and success.