Objective  To evaluate the outcome after the treatment of primary non‐urachal vesical adenocarcinoma and to determine the significant prognostic factors. Patients and methods  The records of 185 patients with vesical adenocarcinoma were reviewed. The pathological evaluation included the determination of pathological stage, tumour grade, presence or absence of mucin and its location, evidence of bilharzial infestation and flow‐cytometric DNA analysis. The mean follow‐up of the treated patients was 3.1 years. Disease‐free survival was estimated and the results correlated with patient and tumour characteristics (univariate analysis). Cox’s proportional hazards analysis was used to determine prognostic factors. Results  The overall 5‐year disease‐free survival was 55%; only three factors had a significant impact on survival, the tumour pathological stage and grade, and lymph node involvement. Conclusions Radical cystectomy remains the only satisfactory treatment option for primary vesical adenocarcinoma. Tumour stage, grade and lymph node involvement are the only significant prognostic factors.

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