To characterise contemporary practice patterns in female radical cystectomy (RC) across the UK and Ireland, focusing on preoperative counselling, operative strategies, and postoperative care.
A 36-item survey was distributed to consultant urologists performing RC, identified via the British Association of Urological Surgeons (BAUS) and Cancer Alliances.
The questionnaire addressed surgeon demographics, preoperative assessment and counselling, operative decision-making including organ- and nerve-sparing techniques, and survivorship care. Responses were analysed descriptively; group comparisons were made using the Wilcoxon rank-sum and Fisher's exact tests.
A total of 64 surgeons responded (56.1% [64/114]), representing 41 cystectomy centres (70.7% [41/58]). Preoperative assessment of sexual activity (68.8%) and menopausal status (78.1%) was common, whereas sexual orientation (15.6%) and prolapse (26.6%) were rarely addressed. Female surgeons were significantly more likely to enquire about menopausal status (P = 0.025). Counselling on sexual dysfunction (98.4%) and vaginal shortening (96.9%) was routine, but other complications, including prolapse (68.8%), menopause (82.8%), or fistula (6.3%), were inconsistently discussed. Organ-sparing practice varied: 28.1% rarely or never performed organ preservation, citing oncological concerns. High-volume centres were more likely to offer organ-sparing RC (P = 0.013). Over half reported inadequate access to female-specific rehabilitation services, with most centres lacking formal pathways for vaginal complications.
Female RC practice across the UK and Ireland is heterogeneous, with clear gaps in preoperative counselling, uptake of organ-sparing techniques, and survivorship care. There is an urgent need for standardised, evidence-based pathways and consensus guidance to optimise outcomes for female patients.
BJU international. 2026 Feb 01 [Epub ahead of print]
Elizabeth Day, Francesco Pio Bizzarri, Elizabeth Waine, Rebecca Martin, Adam W Nelson, Alexandra J Colquhoun, Helena Burden, Benjamin Ayres, Vishwanath Hanchanale, Jonathan Aning, James Douglas, Niyati Lobo
Department of Urology, NHS Ayrshire and Arran, Crosshouse, UK., Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK., Department of Urology, Royal Devon University Healthcare NHS Foundation Trust, Devon, UK., Department of Urology, Royal Marsden NHS Foundation Trust, London, UK., Department of Urology, Bristol Urological Institute, Bristol, UK., Department of Urology, St George's University Hospitals NHS Foundation Trust, London, UK., Department of Urology, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, UK., Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/41622122
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