[Complications and late sequelae following radical cystectomy and supravesicle urinary diversion]

Until recently radical cystectomy combined with urinary diversion was only justified by most urologists as a therapeutic measure for the management of bladder cancer, when other forms of treatment failed controlling the disease. This attitude was mainly based on a high morbidity and mortality rate of up to 20% of the cases. Improved selection of the patients, progress in improving preoperatively the physical conditions of the patients, intra- and post-operative intensive care and improvement of the surgical technique have contributed considerably to reduce the risks of this procedure. Effective preparation of the small and large bowel, early anticoagulation and digitalis medication as well as an efficient antibiotic treatment starting intraoperatively, and optimal parenteral hyperalimentation are of particular importance. Adjuvant preoperative radiation therapy and a simultaneously performed pelvic lymph node dissection do not contribute to an increased morbidity or mortality rate. Taking into account all available preventive measures, the mortality rate of about 20% 20 years ago has been reduced to about 1-5% at present.