Total cystectomy and ureterosygmoidostomy for carcinoma of the bladder

The results obtained in a series of 233 subjects who underwent surgery for total cystectomy and ureterosygmoidostomy for carcinoma of the bladder are analyzed. The immediate and long-term results, the complications and length of survival, both in general and in relation to the stage of the neoplasia, have been considered. The surgical death rate was 7%. Survival, taking all cases into account, was 80% after 1 year, 55% after 3 years, 36% after 5 years and 8.3% after 10 years. Significant differences in survival were found among those patients with pathologic stage PIS-P1-P2 and those with P3-P4. From a survival of 64% after 5 years in the first group, we pass to 23% for P3 and 0% for P4. The precocious complications are anastomosis stenosis (1.8%), uro-fecal fistulae (1.8%) and urinary fistulae (1.4%). Late complications are anastomosis stenosis (13.6%), pyelonephritis with episodes of fever (19.3%), severe acidosis (1.8%) and kidney stones (1.8%).