15th Shanghai Urologic Oncology Academic Conference
Editor’s Note: Hosted by the Shanghai Anti-Cancer Association and jointly organized by the Urologic Oncology Committee of the Shanghai Anti-Cancer Association and Fudan University Shanghai Cancer Center, the 15th Shanghai Urologic Oncology Academic Conference was successfully held in Shanghai from December 12 to 14, 2025. Under the theme “Precision Integration · Intelligent Leadership,” the conference brought together leading experts from China and abroad to engage in in-depth discussions on the most transformative advances in urologic oncology over the past year.
At this meeting, Professor Yiping Zhu of Fudan University Shanghai Cancer Center delivered a lecture entitled “Female Radical Cystectomy with Pelvic Organ Preservation.” In an exclusive interview with Oncology Frontier, Professor Zhu further shared the latest concepts and institutional experience in organ-preserving radical cystectomy for female bladder cancer.
01 | Oncology Frontier: Could you first describe the key differences between radical cystectomy in women and men, and the important evolution in the surgical philosophy of female radical cystectomy?
Professor Yiping Zhu: There is a clear difference in the incidence of bladder cancer between men and women, with a ratio of approximately 3–4:1. Consequently, female patients undergoing radical cystectomy for bladder cancer are relatively fewer in clinical practice. However, there are substantial differences between male and female radical cystectomy, particularly in terms of the extent of resection.
Traditionally, radical cystectomy in women involved not only removal of the bladder, but also en bloc resection of the uterus, adnexa, and anterior vaginal wall. This approach was primarily driven by concerns regarding tumor invasion of the female reproductive organs, as incomplete resection was thought to compromise oncologic control. With the accumulation of clinical evidence, however, it has become apparent that the actual incidence of tumor involvement in these resected female organs is very low.
As a result, organ- and fertility-preserving radical cystectomy has gradually emerged in recent years. Of course, this approach is not suitable for all patients. Candidates should ideally be of reproductive age or sexually active, and the tumor should not be located in the trigone or posterior bladder wall. In addition, preoperative imaging—particularly MRI—should indicate disease no more advanced than T2, preferably below T3.
For female bladder cancer patients who meet these criteria, attempts can be made to preserve reproductive or pelvic organs during radical cystectomy. An increasing body of evidence suggests that, in carefully selected patients, organ-preserving radical cystectomy can achieve oncologic outcomes comparable to those of traditional radical surgery, while significantly improving postoperative quality of life. Although this approach has not yet become the standard of care, it is being actively explored by more and more experts, with growing interest in its future development.
02 | Oncology Frontier: Could you further share your surgical experience in female radical cystectomy, including surgical approach, pelvic floor anatomy and neurovascular bundle preservation, fertility preservation, urinary diversion or reconstruction? In addition, could you discuss your MDT experience at Fudan University Shanghai Cancer Center in the comprehensive management of female bladder cancer?
Professor Yiping Zhu: For female radical cystectomy with the intent to preserve pelvic organs or fertility, the surgical approach is critical. We typically enter through the avascular plane between the bladder and the uterus/anterior vaginal wall. Accurate identification of this anatomical layer is one of the key determinants of surgical success. While there is a certain learning curve, once the anatomy is well understood, bloodless dissection can be reliably achieved.
With respect to fertility preservation, particular attention must be paid to the management of the uterine arteries. During ureteral dissection, care should be taken to avoid injury to these vessels, thereby preserving uterine blood supply. At the same time, complete preservation of the ovaries is essential to maximize reproductive potential.
In addition, the female neurovascular anatomy differs from that of males. When only the bladder is removed, injury to the neurovascular bundles is generally uncommon. This is because ligation of a dorsal venous complex—routine in male cystectomy—is typically unnecessary in women. As a result, preservation of the neurovascular bundles and pudendal blood supply is relatively favorable.
Regarding the multidisciplinary team (MDT) approach in the comprehensive management of female bladder cancer at our center, the primary concern following organ-preserving cystectomy is whether such an approach might increase the risk of tumor recurrence or metastasis. For this reason, we implement a strict postoperative surveillance strategy. During the first two years after surgery, patients are followed up every three months.
For patients who undergo orthotopic neobladder reconstruction, preservation of the uterus is particularly important, as it provides mechanical support to the neobladder. In addition to oncologic surveillance, we closely monitor functional outcomes, including voiding function, continence status, post-void residual urine, and metabolic parameters.
Multidisciplinary treatment is especially relevant for patients with more advanced-stage disease. Depending on individual circumstances, postoperative adjuvant chemotherapy and/or radiotherapy may be considered. As always, treatment decisions must be tailored to each patient based on comprehensive evaluation.
Professor Yiping Zhu Fudan University Shanghai Cancer Center
