As removal of the bladder followed by urinary reconstruction impairs the quality of life (QOL) of patients, cystectomy should be indicated when the benefits surpass the loss of QOL. This means that the primary diseases requiring cystectomy must be severe and oppressive for patients; for example, radiation cystitis with uncontrollable hemorrhage, treatment-refractory vesicovaginal or rectovesical fistula, atrophic bladder and so on. It is possible that the procedures in cystectomy for such benign diseases require high technical skill levels compared with those in radical cystectomy for bladder cancer, but it might depend on the primary disease. There has been no report with a large series regarding morbidity and mortality of cystectomy for benign diseases because of their rarity. Cohn et al. evaluated early and late complications after cystectomy for patients with treatment-refractory benign disease, and attempted to determine associations between the preoperative condition, including the etiology, and such outcomes. All patients with radiation-induced fistula experienced complications within 30 days after the cystectomy, and half of them were Clavien grade III or more. At 90 days, 50% of the patients with radiation-induced fistula still had the preoperative problems, whereas 83% of the rest of the cohort experienced resolution. The authors commented that the morbidity of cystectomy for benign disease might be similar to that seen in radical cystectomy, and increased in particularly complex and comorbid patients with radiation-induced fistula. Although this article has the limitations of being a retrospective review with the probability of underestimation of complications and a small number of participants that do not allow multivariate analysis, it provides informative suggestions for clinical practice. According to recent reports regarding complications of radical cystectomy after radiation therapy, morbidity rates were acceptable and slightly higher than for non-irradiated participants. Unlike salvage cystectomy after radiotherapy as a bladder-preserving strategy, however, cystectomy for patients with uncontrollable radiation-induced fistula is a challenging operation, as shown in this paper. Should we, then, avoid carrying out cystectomy for patients with radiation-induced fistula? To answer this question, much longer follow up and outcome data should be analyzed. Whether the patients who underwent cystectomy for treatment of radiation-induced fistula finally received the real benefits of cystectomy with urinary diversion must be of interest to many urologists.