SUMMARY Six cases of spontaneous rupture of the bladder are described, and reviewed together with sixty‐six cases collected from the literature in the last twenty‐five years. There were sixty‐six cases of intraperitoneal rupture, five cases of extraperitoneal rupture, and one case of combined intraperitoneal and extraperitoneal rupture. The cases of intraperitoneal rupture are classified into two main groups according to whether there was a lesion of the bladder wall or whether the rupture was secondary to retention. The retention group is divided into three sub‐groups: one with neurological disorders, one with urinary obstruction, and a third miscellaneous group, where the rupture is considered to be secondary to a reflex retention. Rupture usually occurs through the vault of the bladder and is usually small in lesions of the bladder wall. Diagnosis depends on a history of pain and disturbance of micturition, and the signs of peritonitis. Catheterisation and withdrawal of blood‐stained urine confirms the diagnosis, but occasionally the urine is clear. The mortality was 47 per cent, and has not fallen during the last twenty‐five years. Carcinoma, tuberculosis, and enlarged prostate accounted for two‐thirds of the mortality.

In a randomized phase III trial performed by the Urological Group of the European Organization for Research on Treatment of Cancer low dose estramustine phosphate (280 mg. twice daily for 8 weeks and 140 mg. twice daily thereafter) was compared to diethylstilbestrol (1 mg. 3 times daily) in patients with stages T3 to T4, M0 or M1 prostatic cancer. Of 248 patients entered 227 were evaluable for analysis: 115 received estramustine phosphate and 112 received diethylstilbestrol. The best response of the local tumor as assessed by palpation was seen in patients receiving diethylstilbestrol. There was no significant difference between treatments for response rate of metastases, interval to local progression, distant progression, over-all survival and death of carcinoma of the prostate. Duration of survival was correlated with the assessment of local response as determined by palpation. The response of distant lesions also was correlated closely with survival. Diethylstilbestrol (1 mg. 3 times daily) was associated with a significantly worse degree of cardiovascular toxicity than estramustine phosphate. This finding was especially obvious in patients who had no history of cardiovascular disease. Gastrointestinal toxicity occurred in 25 patients treated with estramustine phosphate, including 6 in whom cessation of treatment was necessary. Further studies are required to determine the optimum dose of diethylstilbestrol and estramustine phosphate, and to establish the best form of hormonal treatment for prostatic carcinoma.

Radical radiotherapy alone has been compared with radical radiotherapy followed by chemotherapy using doxorubicin (Adriamycin) and 5-fluorouracil in a randomised prospective study on 129 patients presenting with T3, NX, MO transitional cell carcinoma of the bladder. One hundred and ten patients were evaluable with a minimum follow-up of 2 years. The addition of this form of chemotherapy did not appear to influence the survival rate or the proportion of patients free from tumour. It cannot be recommended for routine use in the primary treatment of infiltrating bladder cancer.