Oncological and Functional Outcomes of Radical Cystectomy and Orthotopic Bladder Replacement in Women. Editorial comment

During the last decades, orthotopic bladder substitution (OBS) after radical cystectomy for bladder cancer in women has been increasingly proposed. Meanwhile, strict patient selection criteria, improved surgical techniques, long-term follow-up in large patient cohorts, and validated evaluation have defined the role of OBS in men. Several issues must be clarified in women: oncological outcome, complication rates, functional results, quality of life, and sexual function. As a matter of fact, the results of OBS in women are substantially unchanged in the last decade as stated in this paper. From the oncological standpoint, the patient outcome seems objectively satisfactory but selection criteria are different in the published series. Fortunately, the problem of urethra recurrence seems less relevant in properly selected patients. However several issues are still a matter of debate. Functional results in terms of continence and hypercontinence are still unsatisfactory because the optimal way to reconstruct the pelvic anatomy is still undefined. Early and late complication rates are poorly evaluated. Little data are also available about the quality of life and sexual function. Validated evaluation criteria in a large patient cohort are needed to objectively evaluate the results and to improve the substantially unchanged results reported in last decade. It's time to move forward!!!