To compare peri-operative complications, oncologic outcomes, and patient-reported outcomes between partial cystectomy (PC) and radical cystectomy (RC).
We queried a prospectively maintained database to identify patients undergoing PC and RC for UCB between 1980-2020. Multivariable logistic regression compared 90-day major complications. Multivariable Cox regression examined oncologic outcomes. Quality of life (QoL), urinary symptoms, and decisional regret were assessed in survivors using validated survey instruments.
Among 277 PC patients and 3474 RC patients, PC was associated with fewer 90-day major complications (16.2% vs 33%, p<0.01) and readmissions (5.8% vs 16.1%, p<0.01) After PC, the 5-year intravesical recurrence risk was 40% and 5-year salvage cystectomy risk was 21%. PC did not compromise metastasis-free (HR 1.06, p=0.59) or cancer-specific survival (HR 1.13, p=0.21). Survey response rates were 43% (35/81) for PC and 18% (217/1176) for RC. QoL (p=0.88) and decisional regret (p=0.217) were similar between groups. PC patients had less financial difficulty (6% vs 24%, p=0.01) and were less likely to feel less physically attractive (30% vs 51%, p=0.04). Male PC patients reported less difficulty with erection (58% vs 87%, p<0.001) and ejaculation (35% vs 78%, p<0.001).
Well-selected PC provides similar oncologic outcomes to RC with less peri-operative morbidity and improved QoL. While intravesical recurrence and salvage cystectomy remain risks, guidelines should incorporate PC with adequate post-operative monitoring as an option for select patients with muscle-invasive UCB.
Urology. 2026 Apr 14 [Epub ahead of print]
Austin Martin, Chloe Shi, Gianni Morales Martinez, Cameron Britton, Prabin Thapa, Abhinav Khanna, Stephen A Boorjian, Matthew K Tollefson, Paras Shah, R Jeffrey Karnes, Igor Frank, Vidit Sharma
Department of Urology, Mayo Clinic, Rochester, MN, USA., Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.