Female reproductive organ-sparing radical cystectomy: contemporary indications, techniques and outcomes

Surgical techniques to spare female reproductive organs at the time of radical cystectomy [reproductive organ-sparing radical cystectomy (ROSRC)] have been advocated to improve quality of life with respect to sexual and urinary function. These potential benefits must be weighed against the risk of inappropriate patient selection and related oncologic risk.

In this review, we describe the evidence to define the appropriate selection criteria to minimize clinical understaging. The literature provides small cohorts with intermediate-term follow-up to support oncologic safety, and thus ROSRC must continue to be evaluated with long-term studies. Pertinent techniques for ROSRC are described based on underlying anatomic principles. Lastly, studies on the potential sexual and urinary functional advantages are promising, but must be evaluated in light of the excellent baseline functional characteristics of those selected for inclusion.

ROSRC appears to provide measurable benefits to sexual and urinary function. However, the magnitude of these benefits is unclear and the selection of appropriate candidates requires further prospective study vis-a-vis oncologic control. ROSRC must be adopted cautiously until further data are available.