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Bladder Cancer and Pregnancy

Bladder cancer is typically considered an older person’s disease and therefore is not typically associated with fertility issues or pregnancy. The median age at diagnosis is around 65-70 years old. But some women, 1-2%, do develop bladder cancer under the age of 40.1 Women are also getting pregnant later in life, so there are some crossovers, although pregnancy after bladder cancer continues to be very rare.

Surgical aspects of fertility

At the recent European Urology Conference held in Barcelona, Spain, there were panel discussions addressing some of the unique aspects of treating younger people. One session addressed Surgical Aspects of Fertility in the Young Female Patient with Bladder Cancer. Research from the United Kingdom suggested there is growing attention to pelvic organ preservation surgical techniques for women with muscle-invasive or recurring disease. They presented information on the overlap in the incidence of bladder cancer and fertility, noting that the rate of women giving birth after age 40 drops significantly and that in the UK there is <1% rate of bladder cancer diagnoses in women aged 40-44.1 These cases are infrequent and may more likely be seen in large medical centers.

Uterus-sparing surgery

Two UK studies described had slightly different results. One from 2017 reported no meaningful improvement in sexual or urinary function with uterine-sparing surgery when compared to the standard approach. Yet another study noted that uterus-sparing surgery has several possible benefits for women of childbearing age. They include the potential for better continence (urinary control), standard onset of menopause, and the ability to bear children in younger patients. The study authors note that this procedure is not right for everyone and that a part of the decision-making process should be an exam under anesthesia (EUA) and bladder neck biopsies to confirm diseased areas and lack of spread to other organs. These are important steps to limit the chances of recurrence.

It is clear further investigation is needed to evaluate the safety and benefits of uterine-sparing surgical approaches for women of childbearing age.

Pregnancy and fertility

Another session that also examined related issues was entitled: Fertility in the Young Female Patient with Bladder Cancer – Pregnancy and Fertility: What Do You Need to Know?2This presentation began with the premise that fertility is uncommon after radical treatment for bladder cancer and thus there is little data or experience to draw from. Presenters from the Sorbonne in France, however, sought to compare women being treated for bladder cancer with those who require urinary diversions for other medical reasons such as spinal cord injury or spina bifida.

Risk of UTIs and premature delivery

Women with urinary diversions are at risk for several pregnancy-related conditions, including but not limited to, urinary tract infections (UTIs), and premature delivery. The presenters suggest a multidisciplinary approach, including care by a urologist in addition to an obstetrician, is important to managing patient care and minimizing risks. Doctors need to consider options for delivery of the baby, bacterial colonization, and urinary tract infections, as well as cosmetic issues for young women.

Women with urinary diversions are up to 64% more likely to develop a UTI during pregnancy, increasing the possibility of preterm labor, (delivering the baby before 40 weeks’ gestation). The infections, said the presenters, tend to increase when patients fail to completely empty their urinary reservoir. Urine output increases during pregnancy requiring more frequent and complete emptying.2

Recommendations for pregnant women

  • Seek out a multidisciplinary team for your pregnancy care
  • Deliveries should be at a tertiary care center where experts are more familiar with pregnancy complications.
  • Vaginal delivery is recommended (if possible) if a woman has had urinary diversion.
  • Urologists should be on standby or present in the OR should a caesarian delivery be required2

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Kadow, B. EAU 2019: Surgical Aspects of Fertility in the Young Female Patient with Bladder Cancer. Available at: Accessed 4.5.19.
  2. Kadow, B. EAU 2019: Fertility in the Young Female Patient with Bladder Cancer – Pregnancy and Fertility: What Do You Need to Know? Available at: Accessed 4.4.19.