Radical Cystectomy and Urinary Diversion in Women

Techniques, Outcomes, and Challenges -- A Narrative Review

Markus von Deimling; Ekaterina Laukhtina; Benjamin Pradere; Maximilian Pallauf; Jakob Klemm; Margit Fisch; Shahrokh F. Shariat; Michael Rink


Transl Androl Urol. 2022;11(11):1598-1610. 

In This Article

Abstract and Introduction


Background and Objective: Standard radical cystectomy (RC) in women includes the removal of the bladder, urethra, uterus with the adnexa, and the anterior vaginal wall, thereby severely affecting the urinary, sexual, and reproductive system. To limit these detrimental effects, organ-sparing, including nerve-sparing approaches, have been developed. Health-related quality of life (HRQOL) and functional outcomes are, indeed, becoming increasingly central to the shared decision-making with the patient. The objectives of this narrative review are: (I) to review the current status of RC in women, including the use of different urinary diversions (UDs); (II) to discuss organ-sparing approaches and their impact on oncological and functional outcomes in women; (III) to discuss the impact of RC on HRQOL and sexual function in women.

Methods: We performed a non-systematic literature review of the available publications in the PubMed database.

Key Content and Findings: Over the past years, gender differences in oncological and functional outcomes after RC have received increased attention. According to the currently available literature, organ-sparing approaches can be safely performed in well-selected women without negatively impacting oncological outcomes. The orthotopic neobladder is feasible and oncologically safe in well-selected and informed women. The choice of the UD should be based on comprehensive counseling and the patient's comorbidities and preferences. There still is a lack of data on sexual recovery after the different surgical approaches aimed to mitigate sexual dysfunction in women undergoing RC.

Conclusions: Pre-and post-operative counseling and support of females undergoing RC regarding their expectations and experiences in terms of quality of life and functional and sexual outcomes are currently insufficient. Well-designed studies in this field are necessary to further improve outcomes of women treated with RC with an overarching aim to close the gender gap in managing women with bladder cancer.


Radical cystectomy (RC), including pelvic lymph node dissection with neoadjuvant cisplatin-based therapy when possible, is the standard treatment of localized muscle-invasive bladder cancer (MIBC) and very high-risk non-muscle-invasive bladder cancer.[1,2] Approximately one-fourth of MIBC patients will undergo RC, which is a complex procedure that differs between genders and is associated with high perioperative morbidity.[3–5] Counseling women with bladder cancer requires discussion, regarding the surgical approach and its oncological safety, choice of urinary diversion (UD), and expected and desired postoperative functional outcomes. This review aims to discuss the most important aspects of organ sparing RC, the different types of UD, as well as functional and sexual outcomes after RC in females. We present the following article in accordance with the Narrative Review reporting checklist (available at https://tau.amegroups.com/article/view/10.21037/tau-22-463/rc).