Time to change the template: An oncologic appraisal of organ sparing cystectomy in the female patient

Radical cystectomy (RC) in women for muscle invasive bladder cancer has traditionally involved a full anterior pelvic exenteration, often with significant impact on subsequent quality of life. We performed a nonsystematic literature review of English language peer-reviewed publications available in PubMed between 1980 and 2024. Key search terms included: radical cystectomy, sexual function, continent diversion, urinary diversion, organ sparing, nerve sparing, female, women, exenteration, oophorectomy, ovary sparing, salpingectomy, incontinence, quality of life, and reconstruction. Articles were assessed for relevance. Evidence supports the safety and functional advantages of nerve and organ sparing techniques in appropriately selected female patients. Preserving pelvic anatomy during RC may improve postoperative sexual function, continence, and quality of life. Counseling regarding sexual health and expectations for continence should be systematically integrated into pre and postoperative care. Organ sparing RC in women should be carefully considered in oncologically appropriate patients. Future studies should focus on optimizing patient reported outcomes and guiding shared decision making.