[Radical cystectomy in the therapy of bladder tumors]

Between January 1970 and December 1992, 100 patients (95 males and 5 females) underwent radical cystectomy for bladder cancer. Their mean age was 54.9 years (range, 34-74 years). Indications for radical surgery were multiple superficial tumors (pTa, pT1) in 24 patients and muscle invasive bladder cancer (pT2, pT3b) in 76 patients. Patients with invasive bladder cancer had received elective pre-operative radiotherapy (40 Gy in 20 pts, 20 Gy in 18 pts). Seven patients had undergone salvage cystectomy after full-dose irradiation (60 Gy); 20 pts received pre-operative (neo-adjuvant) chemotherapy (M-VAC or CMV combination) and 11 pts had had no therapy before cystectomy. In 5 pts urinary diversion was performed in advance; in 95 pts cystectomy and urinary diversion were done at the same time. The following methods of urinary diversion were used: ureteroileostomy (Wallace's modification) in 80 pts, Mainz pouch I (ileal conduit with intermittent catheterization) in 6 pts, Mainz pouch with ileourethral anastomosis in 3 pts, ureterosigmoidostomy in 5 pts and Mainz pouch II (continent rectosigmoidal reservoir) in 6 pts. Post-cystectomy mortality was 8.0%. Long-term survival (Kaplan-Meier) following cystectomy was 15-20% of pts with invasive bladder cancer and 30-40% of pts with superficial bladder cancer.