THE HAZARDS OF TOTAL CYSTECTOMY AFTER SUPERVOLTAGE IRRADIATION OF THE BLADDER

Abstract

SUMMARY 1. Supervoltage radiotherapy is being used as treatment in an increasing number of cases of carcinoma of the bladder. It is inevitable that a proportion of these cases will subsequently require cystectomy and urinary diversion for recurrence of the growth or less often for persistent bleeding in the absence of growth. 2. Nine such cases are presented; three of these patients died as a result of leakage from the ureterocolic anastomosis and a further three patients developed non–fatal leakage. The incidence of leakage was much greater than among non–irradiated patients. One of the patients who died also suffered a spontaneous perforation of the colon close to the site of anastomosis. 3. We conclude that the lower end of the ureter should not be used for uretero–intestinal anastomosis in these circumstances, and suggestions are made regarding alterations in operative technique.