[Clinical analysis of 40 total cystectomies for bladder tumor]

Between June, 1983 and December, 1988, 40 patients with primary bladder tumor underwent total cystectomy. Of the 40 patients, 33 (82.5%) were treated by total cystectomy at first presentation. Only 7 patients (17.5%) had prior history of bladder tumors. The mean time from the onset of symptoms to consultation was 11.5 months. In 68.5% of the evaluable 35 patients, gross hematuria was the first symptom. In 74.4% of the 39 evaluable patients, preoperative urine cytology was positive. If class III (suspicious) was included, the positive urine cytology rate was 82.1%. The operative mortality rate was 15%. Early complications occurred in 52.5% of the 40 patients. Late complications occurred in 35.3% of the 34 patients. The 1-, 2- and 3-year actual survival rates of the 40 patients were 69.6%, 65.5% and 65.5% respectively. The 2-year survival rate according to pathologic stage was 14.3% for patients in pT4, 43.8% in pT3b, 75% in pT3a, 100% in pT2, 78.8% in pT1 and 100% in pT0 + pTis. Of the 28 patients who underwent pelvic lymphadenectomy, 8 (28.6%) had positive nodes, including 1 of 1 (100%) in pT4, 5 of 7 (71.4%) in pT3b, 1 of 6 (16.7%) in pT3a, 1 of 4 (25%) in pT2 and 0 of 10 (0%) in pT1 + pT0 + pTis. The prognosis of the 7 patients who had prior history of bladder tumor was poor. The selection of initial therapy and the clinical follow-up should be done carefully.