[Study of a homogeneous series of 27 total cystectomies for cancer]

A homogeneous series of 27 cases of cystoprostatectomy performed for cancer was analysed from two points of view: surgical and carcinological. Surgical treatment in a group of relatively young patients in good general health resulted in low mortality (3.7%) and morbidity (26%) with a mean hospital stay of 23.9 days. In this series, cystectomy was followed by cutaneous ureterostomy (5 cases), Coffey ureterostomy (4 cases), Bricker ureterostomy (8 cases) and 10 replacements. The techniques are described. In 8 cases of replacement, sub-total prostatectomy was performed and, in one half of patients, sexual potency was preserved. There was only one case of superficial recurrence in the graft-urethra junction which was resected without further recurrence after 6 years. Twenty-three patients were treated by radiotherapy and 9 received cis-platinum based chemotherapy. The 5 year survival rate was 22%. The overall survival for N+ tumours, which were the most common in this series, did not exceed 2 years. In contrast, all N- patients are alive after a period of 7 years. At the present time, no decisive role can be attributed to either radiotherapy or chemotherapy. Radical surgery, performed early in the course of the disease, remains the only effective treatment. Furthermore, replacement with preservation of the sphincter decreases the mutilating aspect of cystoprostatectomy.