Is organ preserving radical cystectomy in women oncologically safe and does it improve quality of life?

Introduction: Radical cystectomy in women with bladder cancer traditionally involves removal of reproductive organs, often leading to significant impairment in quality of life. Organ-preserving radical cystectomy (OPRC) has emerged as an alternative approach aimed at maintaining functional outcomes without compromising oncological safety. Methods: This systematic review evaluates current evidence on oncological, surgical, and functional outcomes of OPRC. A comprehensive literature search was conducted using the PubMed, Scopus, and Cochrane databases up to April 2025. Studies were assessed for methodological quality and risk of bias. Results: Fifteen studies (946 female patients) were included in the review. Data on patient selection criteria, operative parameters, recurrence, survival, continence, and sexual outcomes were discussed. Conclusion: OPRC is a safe and effective option for selected women with organ-confined disease. It offers superior functional outcomes and quality of life compared to standard radical cystectomy without compromising oncologic control. Several studies applied strict criteria, including premenopausal, sexually active women with organ-confined (≤T2) disease, away from bladder neck and no genital organ involvement on imaging. However, considerable heterogeneity existed in patient selection and definitions of functional outcomes. Further prospective trials and standardized criteria are warranted. Integrating these findings into practice guidelines could enhance patient-centered care in women undergoing cystectomy. Registration: PROSPERO (CRD420251045355).