Background and Objective: Controversies still exist regarding the ideal proximal extension of lymphadenectomy at radical cystectomy. The objective is to evaluate the outcome of superextended pelvic lymph node (LN) dissection in terms of distribution of LN metastasis, survival benefit in patients undergoing radical cystectomy for urothelial bladder cancer. Patient and methods: A retrospective cohort study of 390 patients with urothelial carcinoma (UC) of the bladder with stage cT2-T4a-NxM0 underwent radical cystectomy (RC) with extended lymphadenectomy (till level of inferior mesenteric artery origin) between April 2008 and April 2016 at uro-oncology unit, Department of Urology, Zagazig University Hospitals. The primary outcome of the study was mapping the distribution of pelvic lymph node metastasis at highest level of LN dissection, while the secondary outcome was survival analysis in relation to the mapping result. Results: Study included 390 patients; 306 men (78%) and 84 women (22%). The mean age was 56±4.4 years. Mean BMI was 30.9±4.5 kg/m2 . The mean number of retrieved lymph node per patient was 28.7±9.8. One hundred and twenty patients (30.7%) had positive LN. LN metastases above bifurcation of common iliac artery were common finding (40% of patients with positive lymph node had metastasis above bifurcation of common iliac artery). No skip metastasis to LN above common iliac artery bifurcation was found. Patients with Negative LN had better survival than patients with positive LN and the survival was not affected by location, number and density of positive LN. Conclusions: Patient survival after radical cystectomy for urothelial carcinoma and extended lymphadenectomy was affected only by the positivity of the LN while other factors such as LN density, location and number didn't significantly affect survival. The external iliac, internal iliac and obturator LNs groups can be regarded as sentinel LN groups as no skip metastasis was found without their affection. Keywords: Extended lymphadenectomy, radical cystectomy, bladder cancer, lymph node, lymph node density.