053 Prospective Evaluation of Patient Reported Sexual Health Outcomes in Men Following Radical Cystectomy

Abstract

Sexual dysfunction in men after radical cystoprostatectomy (RC) is both prevalent and not adequately characterized. Despite improvements in overall survival, patient quality-of-life outcomes continue to be suboptimal. We evaluated sexual health outcomes in male patients undergoing RC and urinary diversion using a self-reported patient questionnaire. After obtaining IRB approval, patients with history of RC and urinary diversion were asked to complete a questionnaire addressing sexual health related outcomes during regularly scheduled follow-up appointments. The questionnaire included the Sexual Health Inventory for Men (SHIM) as well as several supplemental questions addressing libido, medications used to assist in erections, penile prostheses or implants, perceived changes in penile length and curvature, adequacy of preoperative counseling, and interest in maintaining/restoring sexual function. From October 2017 to May of 2018, 127 patients completed the questionnaire. Median age was 68 years and median follow-up from RC was 23.5 months (IQR 11.1-61.7 months). A preoperative SHIM was available in 41 patients, with median score 10.5 (IQR 3-22). Neurovascular preservation (NP) was performed in 36 (27.6%) patients who had a median preoperative SHIM of 22 (IQR 17.5-24). At the time of follow-up, median SHIM was 2 (IQR 1-14) for all patients. On a scale of 1-5, with 1 being very low and 5 being very high, the median rating of libido after surgery was 2 (IQR 1-3). Medications to assist with erections were used in 26 (20.4%) patients with success in 10 (38.4%). 19 (14.9%) patients underwent placement of an inflatable penile prosthesis. Although patients who had NP had higher median post-operative SHIM scores it failed to reach statistical significance (7.5, IQR 1-14 vs 1, IQR 1-9, p=0.075). They did however have significantly higher libido scores compared to those without a NP procedure (3, IQR 2-3 vs 2, IQR 1-3, p<0.001). Significant post-operative differences were also seen with patients who had a penile prosthesis compared to those who did not (median SHIM 22.5, IQR 18-24 vs 1, IQR 1-5, p<0.001 and median libido 3, IQR 3-4.75 vs 2, IQR 1-3, p<0.001). 62 (48.8%) patients said that they perceived a loss of penile length after surgery while 39 (30.7%) were unsure. 13 (10.2%) patients reported penile curvature with erection after surgery. Half of all respondents reported not receiving sufficient counseling on sexual function before cystectomy and 63% reported interest in maintaining or restoring sexual function at the time of survey.