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Summary— A review of the operative risk of cystectomy and urinary diversion performed by one surgeon at one institution over an 8½-year period was performed. Operative mortality was 0.4% (1/229). There were no urinary leaks, 1 bowel leak, 2 bowel obstructions, no rectal injuries and 3 pelvic abscesses. Cystectomy is a safer operation than is usually appreciated, based on improvements in pre-operative preparation, intra-operative monitoring and blood product replacement, and post-operative support if a complication does occur.