Radical cystectomy is the gold-standard treatment for patients with muscle-invasive and very high-risk non-muscle-invasive bladder cancer. In female patients, radical cystectomy has traditionally included removal of the uterus, ovaries, fallopian tubes and anterior vaginal wall.
The majority of female patients undergoing radical cystectomy are postmenopausal, but a subset of patients are premenopausal and experience surgical menopause as a result of bilateral oophorectomy. Surgical menopause results from an abrupt loss of sex steroid hormones, resulting in symptoms such as vasomotor instability and sexual dysfunction, while also increasing the long-term risk of osteoporosis, cardiovascular disease and cognitive decline. The importance of ovarian preservation during radical cystectomy is increasingly recognized; however, oophorectomy might still be indicated in selected premenopausal patients for oncological control. In these individuals, awareness and management of surgical menopause among urologists is often limited, resulting in avoidable morbidity. Thus, when surgical menopause is unavoidable, patients should be counselled regarding symptom management, cardiovascular risk and bone protection; and appropriate hormonal and non-hormonal therapeutic strategies should be implemented where indicated.
Nature reviews. Urology. 2026 Jan 30 [Epub ahead of print]
Elizabeth Day, Francesco Pio Bizzarri, Ciara Mackenzie, Bernadett Szabados, Adam W Nelson, Alexandra J Colquhoun, Matthew J Perry, John D Kelly, Niyati Lobo
Department of Urology, Ayr University Hospital, Ayr, UK., Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK., Department of Gynae-Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK., Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK., Department of Urology, Royal Surrey NHS Foundation Trust, Surrey, UK., Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/41617997
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