New concept in urologic surgery: The total extended genital sparing radical cystectomy in women


Submitted: December 4, 2022
Accepted: December 20, 2022
Published: May 22, 2023
Abstract Views: 1353
PDF: 442
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Authors

  • Antonio Cisternino Department of Urology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
  • Lorenzo Capone Department of Urology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
  • Antonio Rosati Department of Urology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
  • Costanzo Latiano Department of Urology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
  • Nicola Sebastio Department of Urology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
  • Antonio Colella Department of Urology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
  • Giuseppe Cretì Department of Urology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.

Introduction and objectives: The aim of the study was to evaluate genital sparing radical cystectomy surgery in female patients from the point of view of both oncologic and functional outcomes (with emphasis on urinary and sexual outcomes) in a single high-volume center for the treatment of muscular invasive bladder cancer. Materials and methods: Between January 2014 and January 2018, 14 female patients underwent radical cystectomy with preservation of genital organs (the entire vagina, uterus, fallopian tubes, ovaries) and orthotopic urinary neobladder (Padua neobladder). Inclusion criteria were recurrent T1G3 tumors; refractory tumors after BCG therapy without associated carcinoma in situ (CIS); T2 or T3a tumors entirely resected at endoscopic transurethral resection of the bladder and not involving urethra/bladder trigone. Exclusion criteria were: T3b or higher bladder cancer, associated CIS and involvement of urethra or bladder trigone. Oncological and histopathological outcomes (Overall Survival - OS, Recurrence Free Survival - RFS), urinary outcomes (day and night incontinence, intermittent catheterization use, Sandvik Score) and sexual outcomes (Female Sexual Function Index 19 FSFI-19) were considered. The average follow-up time was 56 months. Results: Considering oncological outcomes, histologic examination reported urothelial carcinoma in 13/14 patients; 8/13 patients (61.5%) had high grade T1 stage, 3/13 patients (23%) had high grade T2 stage and finally 2/13 patients (15.5%) had high-grade T3 stage. One patient presented with embryonal rhabdomyosarcoma completely excised after surgery (PT2aN0M0). No patient developed local or metastatic recurrence (RFS 100%); OS was 100%. Considering urinary continence outcomes, 12/14 patients retained daytime and nighttime continence (85.5%); 2/14 (14.5%) complained of low stress urinary incontinence daily and nighttime urinary leakage. The Sandvik Score showed complete continence in 7/14 patients (50%); mild degree incontinence in 6/14 patients without use of incontinence devices (43%); moderate degree of incontinence in one patient (7%). The FSFI administered at 1 year from the surgery showed sexual desire in all patients (100%); subjective arousal, achievement of orgasm and sexual satisfaction in 12/14 patients (85.5%); sufficient lubrication in 11/14 patients (78.5%). Only one patient (7%) complained about dyspareunia during sexual intercourse. Conclusions: Our study aims to demonstrate that genital-sparing radical cystectomy is a safe surgery in terms of oncologic outcomes and, most importantly, that it is beneficial in terms of urinary and sexual function. Indeed, patients’ quality of life together with their psychological and emotional health should be put on the same level as oncological safety. However, it is a treatment reserved for selected patients who are strongly motivated to preserve fertility and sexual function and thoroughly informed about the benefits and complications of such a procedure.


Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021; 71:209-249.

Ferlay J, Colombet M, Soerjomataram I, et al. Cancer statistics for the year 2020: An overview. Int J Cancer. 2021.

Scosyrev E, Noyes K, Feng C, Messing E. Sex and racial differences in bladder cancer presentation and mortality in the US. Cancer. 2009; 115:68-74.

Babjuk M, Burger M, Compérat E, et al. Guidelines on Non-muscle- invasive Bladder Cancer (Ta, T1 and CIS). EAU Guidelines Office, 2022. European Association of Urology Guidelines Office Arnhem, The Netherlands.

Varkarakis IM, Pinggera G, Antoniou N, et al. Pathological review of internal genitalia after anterior exenteration for bladder cancer in women. Evaluating risk factors for female organ involvement. Int Urol Nephrol. 2007; 39:1015-1021.

Kulkarni JN, Rizvi SJ, Acharya UP, et al. Gynecologic-tract sparing extra peritoneal retrograde radical cystectomy with neobladder. Int Braz J Uro. 2008; 34:180-7.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240:205-213.

Rosen R, Brown C, Heiman J, et al. The Female Sexual Function Index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26:191-208.

Sandvik H, Seim A, Vanvik A, Hunskaar S. A severity index for epidemiological surveys of female urinary incontinence: comparison with 48-hour pad-weighing tests. Neurourol Urodyn. 2000; 19:137-45.

Witjes JA, Bruins HM, Carrión A, et al. EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer 2022. Edn. presented at the 37th EAU Annual Congress Amsterdam. European Association of Urology Guidelines Office Arnhem, The Netherlands.

Tang K, Li H, Xia D, et al. Laparoscopic versus open radical cystectomy in bladder cancer: a systematic review and meta-analysis of comparative studies. PLoS One. 2014; 9:e95667.

Kalampokis N, Grivas N, Ölschläger M, et al. Radical Cystectomy in Female Patients - Improving Outcomes. Curr Urol Rep. 2019; 20:83.

Kluth LA, Rieken M, Xylinas E, et al. Gender-specific differences in clinicopathologic outcomes following radical cystectomy: an international multi-institutional study of more than 8000 patients. Eur Urol. 2014; 66:913-9.

Messer JC, Shariat SF, Dinney CP, et al. Female gender is associated with a worse survival after radical cystectomy for urothelial carcinoma of the bladder: a competing risk analysis. Urology. 2014; 83:863-7.

Cohn JA, Vekhter B, Lyttle C, et al. Sex disparities in diagnosis of bladder cancer after initial presentation with hematuria: a nationwide claims-based investigation. Cancer. 2014; 120:555-61.

Weissbart SJ, Smith AL. Hysterectomy in the Urologist's Practice. Curr Urol Rep. 2017; 18:4.

Ali-el-Dein B, el-Sobky E, Hohenfellner M, Ghoneim MA. Orthotopic bladder substitution in women: functional evaluation. J Urol. 1999; 161:1875-80.

Ali-El-Dein B, Abdel-Latif M, Mosbah A, et al. Secondary malignant involvement of gynecological organs at radical cystectomy specimens in women: is it mandatory to remove these organs routinely? J Urol. 2004; 172:885-7.

Groutz A, Gillon G, Konichezky M, et al. Involvement of internal genitalia in female patients undergoing radical cystectomy for bladder cancer: a clinicopathologic study of 37 cases. Int J Gynecol Cancer. 1999; 9:302-306.

Huang H, Yan B, Shang M, et al. Is hysterectomy beneficial in radical cystectomy for female patient with urothelial carcinoma of bladder? A retrospective analysis of consecutive 112 cases from a single institution. BMC Urol. 2019; 19:28.

Moursy EE, Eldahshoursy MZ, Gamal WM, Badawy AA. Orthotopic genital sparing radical cystectomy in pre-menopausal women with muscle-invasive bladder carcinoma: A prospective study. Indian J Urol. 2016; 32:65-70.

Roshdy S, Senbel A, Khater A, et al. Genital Sparing Cystectomy for Female Bladder Cancer and its Functional Outcome; a Seven Years' Experience with 24 Cases. Indian J Surg Oncol. 2016; 7:307-11.

Borghi C, Manservigi M, Milandri ES, et al. The impact of orthotopic reconstruction on female sexuality and quality of life after radical cystectomy for non-malignant bladder conditions. Arch Ital Urol Androl. 2021; 93:255-261.

Ali-El-Dein B, Mosbah A, Osman Y, et al. Preservation of the internal genital organs during radical cystectomy in selected women with bladder cancer: a report on 15 cases with long term follow-up. Eur J Surg Oncol. 2013; 39:358-64.

Niver BE, Daneshmand S, Satkunasivam R. Female reproductive organ-sparing radical cystectomy: contemporary indications, techniques and outcomes. Curr Opin Urol. 2015; 25:105-10.

Puppo P, Introini C, Calvi P, Naselli A. Pelvic floor reconstruction before orthotopic bladder replacement after radical cystectomy for bladder cancer. Urology. 2005; 65:174.

Cisternino, A., Capone, L., Rosati, A., Latiano, C., Sebastio, N., Colella, A., & Cretì, G. (2023). New concept in urologic surgery: The total extended genital sparing radical cystectomy in women. Archivio Italiano Di Urologia E Andrologia, 95(2). https://doi.org/10.4081/aiua.2023.11058

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