This report presents the results of 40 salvage cystectomies performed after failure of radiation therapy to control the disease in patients with bladder cancer. All patients had failure or recurrence after 7,000 rad. The time between end of radiation therapy and cystectomy was three to six months in 11 patients, seven to twelve months in 15, thirteen to twenty-four months in 8, and longer than thirty-six months in 6. There were two immediate and four late postoperative deaths. A total of twenty-two complications occurred in 16 patients. The five-year survival rate was 100 per cent for patients with in situ carcinoma, 58 per cent for Stage A disease, 50 per cent for Stage B1, and 40 per cent for Stage B2 disease. There were no survivors among patients with Stages C and D1 disease. Salvage cystectomy, although associated with significant morbidity, remains a viable form of therapy for patients in whom definitive radiotherapy fails.