Objective: To compare the clinical effects and safety of two methods of laparoscopic total cystectomy for female bladder cancer patients with retention and resection of the urethra. Methods: Female bladder cancer patients with bladder invasive urothelial carcinoma were selected in grade II~III from January 2008 to March 2018. Patients were divided into two groups based on the surgical method: group A laparoscopic radical cystectomy, and group B laparoscopic radical cystectomy + urethrectomy, to observe the clinical efficacy, operation duration, blood loss during surgery, hospitalization time, and complications. Results: The operation times in groups A and B were 262.54 ± 27.95 min and 310.28 ± 32.99 min, respectively. The volumes of intraoperative blood loss in groups A and B were 439.46 ± 44.52 mL and 456.74 ± 47.18 mL, respectively. There were no discernable differences in the probability of postoperative complications in the two groups. In group A, four patients experienced bladder cancer recurrence and metastasis, and 50% of these cases had a urethral recurrence. In group B, one patient experienced bladder cancer recurrence and metastasis; however, there was no urethral recurrence. Conclusion: Although laparoscopic radical cystectomy + urethrectomy extended the operation times; prophylactic urethrectomy can further shorten the bladder cancer recurrence and metastasis and improve patient prognosis without an increase in complications. However, its long-term clinical efficacy needs further study and supplement.