The surgical treatment of tumors of the bladder is surrounded by a host of difficulties. Chief among these are to be mentioned, first, the importance of preserving the anatomic relationship; second, the complications arising from the multiplicity of tumor types, and third, the inaccessibility of the lesion.
The anatomic relationship must be preserved in order to maintain function. It is necessary to preserve the orifice into the bladder for the ureters and, if one or both of them be destroyed, one or both of the ureters must be transplanted so as to enter the bladder at some other point. It is also necessary to maintain the normal outlet with its muscular mechanism and power of urinary control.
While most tumors of the bladder are papillomas, they occur frequently in multiple form. Usually there are one large and several small tumors. The large tumor is apt to overshadow the smaller tumors, one of which may easily escape notice. Recurrence of papillomas is seldom local, but is often seen in a different quadrant of the viscus. Cells brushed off in removing the tumor are prone