Nineteen patients with severe intractable interstitial cystitis were treated surgically with either cecocystoplasty, urinary diversion with or without cystectomy, cystolysis or segmental bladder resection. Of the 6 patients who underwent an augmentation cecocystoplasty 4 were cured and 2 ultimately had urinary diversion before cure. Of the 7 patients who underwent urinary diversion with or without total cystectomy 6 were cured. In the cystolysis group the suprapubic pain was relieved either totally or partially in all 5 cases, and nocturia and urinary frequency were reduced substantially in each. However, only 1 patient was cured completely of all symptoms. The patient who underwent segmental resection of the bladder experienced only temporary symptomatic relief. Postoperative complications included pyocystis in 2 patients who had urinary diversion without cystectomy and hydroureteronephrosis in 1 patient after ureterosigmoidostomy that required multiple procedures. The place for each of these major surgical procedures in the treatment of intractable interstitial cystitis is discussed.