The clinical courses of 119 patients with unresectable bladder cancer were analyzed. All patients had a laparotomy with the intent of cystectomy. TN categorization postlaparotomy did not identify variables significantly influencing the natural history of the disease, although previous definitive irradiation or T4aNx-4 categories were associated with especially poor survival. T category correlated more closely with survival than did N category. Supravesical urinary diversion palliated patients with urinary symptoms and/or bilateral ureteral obstruction. Patients without compelling urinary symptoms at the time of laparotomy uncommonly needed diversion later. Pelvic irradiation and systemic chemotherapy available in the interval from 1961 to 1976 had minimal if any demonstrable effect on the time course of the disease.