Sparing urethra in women at the time of cystectomy: retrospective comparison of cystectomies with and without urethrectomy.

BACKGROUND

In female patients undergoing cystectomy where orthotopic bladder reconstruction is not an option, urethrectomy is typically performed. Unlike in males, female urethrectomy carries a risk of damaging clitoral structures and nerves, potentially contributing to post-cystectomy sexual dysfunction. This study evaluates overall survival in women undergoing cystectomy with versus without urethrectomy.

METHODS

A retrospective review of electronic medical records from 2000 to 2023 was conducted. Radical cystectomy specimens were reviewed for surgical details, tumor characteristics, urethral involvement, and urethrectomy status. Institutional criteria required urethrectomy in patients receiving neobladder reconstruction.

RESULTS

Among 347 women who underwent cystectomy, 298 received urethrectomy and 49 did not. The mean age was 65.4 years. Urethral involvement was present in 15 cases (7%). One patient with a neobladder and positive urethral margin remained disease-free at 5 years. At the last follow-up, 54.2% of patients with urethrectomy and 61.2% without urethrectomy showed no evidence of disease. A total of 76 patients (26.5%) were alive with disease, 62 (20.8%) in the urethrectomy group and 14 (28.6%) in the non-urethrectomy group. Kaplan-Meier analysis showed mean overall survival of 246.9 months with urethrectomy vs. 173.9 months without. Propensity score matching (2:1) included 70 urethrectomy and 35 non-urethrectomy patients. Kaplan-Meier and Cox regression analyses showed no significant survival difference (P=0.07).

CONCLUSIONS

Urethra-sparing cystectomy in women may be oncologically safe when no urethral involvement is present and should be considered to preserve sexual function.