Twenty patients with bladder carcinoma underwent total cystectomy and one-stage urinary diversion after a definitive external radiotherapy. The indication for surgery was a persistent or locally recurrent tumor and/or intractable voiding symptoms. There was no operative mortality. Early or late complications occurred in 14 patients (70%) and in 7 of these cases a reoperation was necessary. The overall 5-year survival rate after the operation was 61%. The prognosis of the patients was dependent on the pathological stage of the tumor in cystectomy specimens.