Aim: To reduce the possibility of local pelvic recurrence after radical cystectomy for stage P3 and P4a bilharzial bladder 
cancer by performing extended pelvic dissection in order to accomplish complete clearance of the anterior part of the pelvic cavity. 
Methods: A prospective study which was done in the period between 1998 and 2000. Forty-one patients (38 males and 3 females) having stage P3 – P4a bilharzial bladder cancer underwent radical cystectomy (or anterior pelvic excentration in 
females) with extended pelvic dissection to include and remove the parietal endopelvic fascia to achieve complete clearance of the anterior part of the pelvic cavity. Five patients were excluded and 36 patients were followed up for 5 years. 
Results: There was one post-operative mortality. Local recurrence occurred in 16.6% of these patients. Five patients with 
tumor invasion to the prostate developed early vertebral metastases. The 5 year Disease Free Survival for all patients in 
stage P3 and P4a was 55.6%. It was 67.9% for stage P3 patients and was only 12.5% for stage P4a patients. 
Conclusion: A reduced incidence of pelvic recurrence could be achieved by a meticulaous and extended pelvic dissection to achieve complete clearance of the anterior part of the pelvic cavity. 
Tumor invasion to the prostate represents a major problem that could be studied and solved.