TOTAL cystectomy, for primary or metastatic carcinoma of the urinary bladder, with anastomosis of the ureters into the intact colon, is a procedure that is, at best, only reluctantly recommended by urologist and surgeon and similarly accepted by the patient. USUALLY ACCEPTED REASONS FOR DELAYING TOTAL CYSTECTOMY WITH URETEROSIGMOIDOSTOMY Many factors militantly array themselves against ready, free, earlier, and more universal employment of the procedure. It has long been known among urologists, and generally accepted by them, that the papillary type of vesical carcinoma is an entity which lends itself to amelioration, if not cure, by the less formidable attack of repeated fulguration, sometimes over a period of many years. It has been generally agreed, however, that the infiltrative type of carcinoma is a much more resistant lesion, failing to respond to roentgen therapy, interstitial radiation, or fulguration, or to a combination of these, and it is in this type