Anatomic basis of radical cystectomy and orthotopic urinary diversion in female patients

Long considered oncologically hazardous or functionally damaging, radical cystectomy with orthotopic urinary diversion is the accepted standard of care for invasive bladder cancer. A number of anatomical and clinical observations have come together to make orthotopic urinary diversion possible for female patients. Not only have these observations led to the development of an oncologically safe, low-pressure reservoir for urine, but also have improved the postoperative quality of life. Urethral sparing technique is safe for patients without bladder neck or trigonal tumors. Furthermore, improved understanding of the female urethral rhabdosphincter has decreased the likelihood of postoperative urinary incontinence. Finally, female sexual function may be preserved in patients who undergo preservation of the neurovascular tissue lateral to the vagina. These improvements have solidified orthotopic urinary diversion as the procedure of choice for selected female patients requiring radical cystectomy.