Abstract
Four hundred twenty patients with bilharzial bladder cancer were treated by radical cystectomy. The majority (80.9%) of these cases belonged to the clinically advanced stages T3 and T4. This was confirmed pathologically where P3 accounted for 70.7% and P4 for 24.5% of the cases. There was a clinical error in staging of 133 cases (31.6%), with clinical understimation in 127 cases (30.2%). Pathological examination showed that the posterior wall was the commonest site of origin (61%), nodular fungating was the most frequent type and squamous cell carcinoma was encountered in 68.2% of cases. Multicentric tumors were present in 7% of cases. The rectal bladder was the commonest form of urinary diversion used (51%). This represents the general trend in the Cairo National Cancer Institute, since the rectal bladder is considered to be the most suitable method for Egyptian patients. Radical cystectomy was associated with 14% postoperative mortality and 34% postoperative morbidity. Septic complications were the main etiological factors. The actuarial survival rate was 61.7% by the end of the first year, dropping to 39% at the end of the third year. Local pelvic recurrence constituted the main cause of treatment failure (72.6%) and was responsible for 81.3% of the failures during the first year.