Surgery in Motion Radical Cystectomy and Orthotopic Bladder Replacement in Females Udo Nagele *, Markus Kuczyk, Aristotelis G. Anastasiadis, Karl-Dietrich Sievert, Jo ¨ rg Seibold, Arnulf Stenzl Department of Urology, University of Tuebingen, Germany 1. Introduction More than 15 years ago, several centers started to offer urethra-sparing cystectomy and orthotopic urinary diversion also to female patients diagnosed with bladder cancer [1–4]. Up to this point in time, removal of the female urethra was considered an integral part of cystectomy. It was argued that renunciation of a urethrectomy would be associated with an increased risk for the development of intraurethral tumor recurrences. In addition, because of specific compli- cations associated with the latter procedure, such as fistulation to the vagina or postoperative micturition problems either in the form of urinary retention or the subsequent development of urinary incontinence, orthotopic bladder replacement in females was not introduced into the clinical routine as rapidly as in male patients. After it was demonstrated that, with respect to certain oncologic prerequisites, the urethra could be safely preserved, we now have a better european urology 50 (2006) 249–257 available at www.sciencedirect.com journal homepage: www.europeanurology.com Article info Article history: Accepted May 3, 2006 Published online ahead of print on June 21, 2006 Keywords: Cystectomy Neobladder Urinary diversion Bladder substitute Female patient Abstract Introduction: More than 15 years ago, several centers started to offer urethra-sparing cystectomy and orthotopic urinary diversion for female patients with bladder malignancies. Several studies have been pub- lished, outlining both the anatomical and oncological aspects of such an approach. Methods: In this contribution, the main aspects regarding the surgical technique of cystectomy and orthotopic urinary diversion in female patients, including technical variations which have been derived over the years, are presented. Results and Conclusion: The video shows a detailed description of the surgical technique, and the main steps of the procedure are demon- strated in schematic drawings as well as in animations to facilitate understanding. Emphasis is given on important anatomical and physio- logical aspects, which have influenced the current surgical steps. Pos- sible sequelae on oncological and functional outcome, which play an important role in the evaluation of this procedure, are also discussed. # 2006 European Association of Urology. Published by Elsevier B.V. All rights reserved. * Corresponding author. Department of Urology, University of Tuebingen, Hoppe-Seyler-Str. 3, Tuebingen 72076, Germany. Tel. +49 7071 2986615; Fax: +49 7071 2985092. E-mail address: Udo.Nagele@med.uni-tuebingen.de (U. Nagele). 0302-2838/$ – see back matter # 2006 European Association of Urology. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.eururo.2006.05.037