US survey data demonstrate wide variation in counselling and operative practice for women undergoing RC.1-3 However, contemporary practice outside North America has remained largely unexamined. Our recent UK and Ireland survey addresses this gap, revealing substantial variation across the entire care pathway—from pre-operative counselling and operative decision-making to survivorship care.
In the pre-operative setting, counselling practices are heterogeneous. Although almost all surgeons routinely discuss the risk of sexual dysfunction (98%) and vaginal shortening (97%), far fewer counsel patients regarding pelvic organ prolapse (69%) or vaginal fistula (6%), despite these being recognised complications with significant functional impact. Furthermore, fewer than one in five surgeons routinely ask about sexual orientation, and only 27% assess prolapse pre-operatively.
Variation is also evident in operative practice. Despite guideline support from both the EAU and AUA for gynaecological organ-sparing approaches in appropriately selected patients,4,5 more than a quarter of respondents reported that they rarely or never perform organ-sparing RC, most commonly citing oncological concerns. High-volume centres were significantly more likely to offer organ preservation. However, important questions remain unanswered: How do we balance the risk of upstaging with organ-preservation? What role should MRI play in pre-operative planning? How should subtype histology influence decision-making?
Postoperative care represents perhaps the greatest unmet need. Over half of respondents reported inadequate access to female-specific rehabilitation services, and nearly two-thirds lacked any formal pathway for managing vaginal complications, despite these being well-recognised sequelae of RC.6 This gap between surgical intervention and survivorship support risks leaving women to manage complex, distressing complications without structured follow-up or specialist input.
While our survey captures surgeon-reported practice rather than procedural-level data and is therefore subject to recall and reporting bias, its findings demonstrate that variation in female RC care is not confined to a single healthcare system. Rather, it reflects a broader absence of consensus around counselling standards, operative decision-making, and survivorship pathways. It is time to move beyond documenting variation and towards developing consensus-driven, evidence-based standards that ensure equity- so that quality of care for women undergoing RC is defined by best practice, not postcode.
Written by:
- Elizabeth Day Department of Urology, Ayr University Hospital, Ayr, UK
- Niyati Lobo, Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Gupta N, Kucirka LM, Semerjian A et al. Comparing provider-led sexual health counseling of male and female patients undergoing radical cystectomy. J Sex Med 2020; 17: 949–56
- Sussman RD, Han CJ, Marchalik D et al. To oophorectomy or not to oophorectomy: practice patterns among urologists treating bladder cancer. Urol Oncol 2018; 36: 90.e1–7
- Gupta N, Kucirka L, Semerjian A et al. Practice patterns regarding female reproductive organ-sparing and nerve-sparing radical cystectomy among urologic oncologists in the United States. Clin Genet 2023; 21:e236–41
- Van der Heijden A, Bruins HM, Carrion A et al. European Association of Urology Guidelines on Muscle-Invasive and Metastatic Bladder Cancer, 2025th edn. Arnhem, The Netherlands: EAU Guidelines Office, 2025. ISBN 978-94-92671-29-5
- Holzbeierlein J, Bixler BR, Buckley DI et al. Treatment of non-metastatic muscle-invasive bladder cancer: AUA/ASCO/SUO guideline (2017; Amended 2020, 2024). J Urol 2024; 212: 3–10
- Kalen E, Ginstman C, Liedberg F et al. Incidence and risk factors for postoperative vaginal events following radical cystectomy for bladder cancer: a nationwide population-based study. BJU Int 2025; 136:1128–36