Adequate Sexual Function Research Articles

(404) Early Experience of Penoscrotal Decompression for Refractory Ischemic Priapism and Its Impact on Sexual Function

Abstract Introduction Outcomes after distal shunting have low rates of success in cases of refractory ischemic priapism lasting more than 48 hours. Objective Our objectives are to report our institutional experience using penoscrotal decompression for the surgical treatment of prolonged and refractory ischaemic priapism. The primary end point is to assess priapism resolution in the patients. While the secondary end point is to assess erection recovery in those patients. Methods We prospectively evaluated refractory and prolonged ischemic priapism patients treated with proximal decompression from 2020-2022 at Alexandria Main University Hospital. Priapisms were confirmed as ischaemic based on clinical presentations, cavernosal blood gas abnormalities, and doppler ultrasound. Treatment with irrigation and injection of α-agonists in all patients had failed prior to PSD. Patient characteristics, peri-operative variables and outcomes, and changes in International Index of Erectile Function (IIEF) scores were evaluated. Results Thirteen patients with priapism who had treated with penoscrotal decompression from 2020 to 2022. Their age was 28-53 years. The duration of ischemic priapism was 48 hours to 10 days. Nine patients had previously undergone shunt surgery. All patients were successfully treated with Penscrotal deecompression without additional intervention and noted immediate relief of pain postoperatively. Of the 10 patients with documented sexual function status at last follow-up, six reported spontaneous erectile function adequate for penetration, while four reported erectile dysfunction. Conclusions Penoscrotal decompression proved to be an effective and safe way of managing refractory ischemic priapism. The technique showed to produce favorable results while maintaining adequate sexual function. Disclosure Yes, this is sponsored by industry/sponsor: alexandria main university hospital. Clarification Industry initiated, executed and funded study Any of the authors act as a consultant, employee or shareholder of an industry for: alexandria main university hospital.

The Effect of Post-Operative Sexual Counseling Carried out with PLISSIT Model on Sexual Function and Sexual Satisfaction in Gynecologic Cancers

Objective: This study aims to determine the effect of sexual counseling on the sexual functions and sexual satisfaction of women who underwent surgical treatment due to gynecologic cancer. 
 Methods: The study sample consisted of 60 women (experimental group n = 30, control group n = 30) with ovarian, endometrial, and cervical cancer. The women in the experimental group received sexual counseling according to PLISSIT, while the women in the control group were not given sexual counseling but were monitored through routine follow-up. The Female Sexual Function Index (FSFI) and the Sexual Satisfaction Scale for Women (SSS-W) were used for the first and last evaluations of the groups.
 Results: The mean age of the women in the experimental group was 51.87 ± 8.89, while it was 50.47 ± 9.43 in the control group. There was no significant difference between the two groups in terms of sexual function and sexual satisfaction levels in the first evaluation (p>.05), whereas there was a significant difference between the two groups in the final evaluation after the sexual counseling provided to the experimental group (p < .001). When the first and final evaluations of the women were considered, it was observed that 33.3% of the women in the experimental group had adequate sexual functioning in the final evaluation.
 Conclusion: The sexual counseling carried out using the PLISSIT model for women who were treated for gynecologic cancer positively affected their sexual function and sexual satisfaction levels.

MP79-06 COMPLIANCE OF DAPOXETINE IN PATIENTS WITH PREMATURE EJACULATION: A 2-YEAR PROSPECTIVE OBSERVATIONAL STUDY

You have accessJournal of UrologyCME1 Apr 2023MP79-06 COMPLIANCE OF DAPOXETINE IN PATIENTS WITH PREMATURE EJACULATION: A 2-YEAR PROSPECTIVE OBSERVATIONAL STUDY Hyun Jun Park Hyun Jun ParkHyun Jun Park More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003356.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although dapoxetine is the only oral pharmacological agent approved for the treatment of premature ejaculation (PE), and is very effective, the discontinuation rate is high. We assessed the discontinuation rate in patients with PE, and the reasons for discontinuation, in real-world practice. METHODS: A total of 182 consecutive patients were enrolled. The type of PE, the self-estimated intravaginal ejaculation latency time (IELT), and medical history were evaluated in all patients, who also completed the International Index of Erectile Function-Erectile Function Domain (IIEF-EFD) questionnaire. Visits were scheduled 1, 3, 6, 12, and 24 months after initiation of therapy; we checked treatment status and the reasons for discontinuation in those who did in fact discontinue. We compared the relationships of discontinuation rates with various parameters and the time to discontinuation after treatment commencement. RESULTS: Of all patients, 9.9% continued treatment to 2 years. The cumulative discontinuation rates at 1, 3, 6, 12, and 24 months were 26.4%, 61.6%, 79.1%, 87.3%, and 90.1%, respectively. 79.1% of all patients discontinued treatment within 6 months. After 12 months, however, the discontinuation rate fell sharply. The reasons for discontinuation were cost (29.9%), disappointment that PE was not curable and that dapoxetine was required every time sexual intercourse was contemplated (25%), side effects (11.6%), perceived poor efficacy (9.8%), a search for other treatment options (5.5%), and unknown (18.3%). Patients with acquired PE (compared to lifelong PE), with IELT >2 min prior to treatment, on PDE-5 inhibitors, and with IIEF-EF scores <26 tended to discontinue early and thus exhibited high drop-out rates. CONCLUSIONS: The treatment discontinuation rate of dapoxetine was very high. The main reasons for discontinuation were the cost and disappointment that treatment was required every time adequate sexual function was required. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1143 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hyun Jun Park More articles by this author Expand All Advertisement PDF downloadLoading ...

PD42-05 DOES PENOSCROTAL DECOMPRESSION OUTPERFORM CORPOROGLANULAR TUNNELING FOR SURGICAL MANAGEMENT OF PROLONGED ISCHEMIC PRIAPISM?

You have accessJournal of UrologyCME1 Apr 2023PD42-05 DOES PENOSCROTAL DECOMPRESSION OUTPERFORM CORPOROGLANULAR TUNNELING FOR SURGICAL MANAGEMENT OF PROLONGED ISCHEMIC PRIAPISM? Maia E. VanDyke, Wesley J. Smith, Brian T. Langford, Benjamin N. Breyer, Faysal A. Yafi, David W. Barham, Niels V. Johnsen, Levi C. Holland, Benjamin M. Dropkin, Mikkel Fode, Bryce P. Franzen, Steven J. Hudak, and Allen F. Morey Maia E. VanDykeMaia E. VanDyke More articles by this author , Wesley J. SmithWesley J. Smith More articles by this author , Brian T. LangfordBrian T. Langford More articles by this author , Benjamin N. BreyerBenjamin N. Breyer More articles by this author , Faysal A. YafiFaysal A. Yafi More articles by this author , David W. BarhamDavid W. Barham More articles by this author , Niels V. JohnsenNiels V. Johnsen More articles by this author , Levi C. HollandLevi C. Holland More articles by this author , Benjamin M. DropkinBenjamin M. Dropkin More articles by this author , Mikkel FodeMikkel Fode More articles by this author , Bryce P. FranzenBryce P. Franzen More articles by this author , Steven J. HudakSteven J. Hudak More articles by this author , and Allen F. MoreyAllen F. Morey More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003352.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prolonged ischemic priapism (PIP) presents a rare and challenging urological condition, often requiring advanced surgical maneuvers for resolution. We sought to evaluate current practice patterns in the management of this challenging condition using a multi-institutional survey. METHODS: A 38-question, web-based survey was distributed to clinically active urologic surgeons including members of the Society of Genitourinary Reconstructive Surgeons (GURS) and the Sexual Medicine Society of North America (SMSNA). PIP was defined as priapism duration of at least 24 hours prior to presentation. Questions highlighted experience with and perceived efficacy of adjunctive maneuvers including distal shunting, corporoglanular tunneling (CGT) and penoscrotal decompression (PSD). Also queried were surgeons’ impressions of the prevalence of erectile dysfunction after priapism surgery. RESULTS: One hundred fifteen responses were received following survey distribution. Tunneling procedures (CGT and PSD) were the favored first-line intervention for PIP over implants (80/114 tunneling vs. 11/114 implant, p<.001). Respondents were more likely to have performed CGT than PSD (110/113 for CGT vs. 74/112 for PSD, p<.001), but among those who had performed both, PSD was felt to be more than twice as effective at resolving PIP (33/63, 52% Very or Extremely Effective for PSD, vs. 13/64, 20% for CGT; p<.001, Figure 1). For patients with recurrent priapism after CGT, PSD was the preferred salvage procedure for 46% of surgeons (46/99) while immediate implant was favored by 40% (40/99, p=.390). Regarding sexual function, a similar number of respondents who had performed both tunneling procedures felt that at least half of patients regained adequate sexual function after either CGT or PSD (27/61, 44% vs. 25/60, 42%; p=.773). CONCLUSIONS: PSD is perceived by surgeons as more effective than CGT for prolonged ischemic priapism and is commonly chosen as a salvage procedure when CGT fails. Many surgeons feel that patients regain erectile function after tunneling procedures, avoiding the need for expensive prosthetics. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1112 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Maia E. VanDyke More articles by this author Wesley J. Smith More articles by this author Brian T. Langford More articles by this author Benjamin N. Breyer More articles by this author Faysal A. Yafi More articles by this author David W. Barham More articles by this author Niels V. Johnsen More articles by this author Levi C. Holland More articles by this author Benjamin M. Dropkin More articles by this author Mikkel Fode More articles by this author Bryce P. Franzen More articles by this author Steven J. Hudak More articles by this author Allen F. Morey More articles by this author Expand All Advertisement PDF downloadLoading ...

V12-12 PENOSCROTAL DECOMPRESSION OF REFRACTORY ISCHEMIC PRIAPISM: SURGICAL TECHNIQUE

You have accessJournal of UrologyCME1 May 2022V12-12 PENOSCROTAL DECOMPRESSION OF REFRACTORY ISCHEMIC PRIAPISM: SURGICAL TECHNIQUE Nicholas Ottaiano, Ganesh Sanekommu, Christopher Koller, Wayne Hellstrom, Allen Morey, and Omer Raheem Nicholas OttaianoNicholas Ottaiano More articles by this author , Ganesh SanekommuGanesh Sanekommu More articles by this author , Christopher KollerChristopher Koller More articles by this author , Wayne HellstromWayne Hellstrom More articles by this author , Allen MoreyAllen Morey More articles by this author , and Omer RaheemOmer Raheem More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002638.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Outcomes after distal shunting have low rates of success in cases of refractory ischemic priapism lasting more than 48 hours. Current American Urological Association (AUA) guidelines recommend proximal shunting following a failed distal shunt; however, proximal shunting is no longer common practice due to the technically challenging nature of the procedure. METHODS: A 43 year old African American male presented to our institutional hospital from an outside hospital for refractory ischemic priapism lasting longer than 72 hours. Corporal blood gas analysis confirmed priapism of ischemic nature, penile duplex ultrasound confirmed an absence of blood flow. The remaining lab work (CBC, urine toxicology, and Hb electrophoresis) was negative. Corporal decompression via a penoscrotal approach was then performed in hopes of preserving the patient's erectile function. RESULTS: Penoscrotal decompression proved to be an effective and safe way of managing refractory ischemic priapism. The technique showed to produce favorable results while maintaining adequate sexual function. Longer follow up periods and a larger patient size is needed for future evaluation. CONCLUSIONS: Corporal decompression via a penoscrotal incision has recently emerged as a viable alternative to proximal shunting with favorable outcomes in select patients. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e970 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nicholas Ottaiano More articles by this author Ganesh Sanekommu More articles by this author Christopher Koller More articles by this author Wayne Hellstrom More articles by this author Allen Morey More articles by this author Omer Raheem More articles by this author Expand All Advertisement PDF DownloadLoading ...

Physician and Patient Reported Morbidity After MR-Guided Salvage Brachytherapy for Prostate Cancer

Local salvage brachytherapy (BT) after previous radical radiotherapy (RT) in prostate cancer (PC) may cause additional toxicities that negatively impact quality of life (QoL). We report on QoL for patients treated in a prospective study.From 2009 to 2020, 50 PC patients underwent 2 fractions of MR-guided HDR salvage BT (MRgHDRBT) for locally recurrent disease after RT in 2 non-randomized cohorts. Cohort 1 had whole gland treated with total 16 Gy with an integrated boost (wgBT) of 22 Gy to GTV. Cohort 2 had focal HDR (fBT) to total 26 Gy. GTV was defined on multiparametric MRI. For wgBT the GTV-PTV expansion was 2mm except 4 mm superior-inferior (s/i). For fBT, GTV-CTV expansion was 5 mm restricted to within 2 mm of the prostate and PTV of 2 mm s/i. Toxicity was assessed using CTCAE v4 and the Expanded Prostate Cancer Index Composite (EPIC) for QoL at baseline and after HDR. Multivariable linear regression model accounting for repeated measurements within individual and adjusting for baseline score and time was fitted to compare cohorts and to assess association between dosimetry and QoL.The median age was 71 (range 62,85) with a median follow-up of 60.5 (6,134) months. Thirty-seven (74%) patients had fBT, and 13 (26%) wgBT. The median GTV-PTV volume, was 7 cm (3.6,18.4) and 7.5 cm (3.2,16.4) per fraction in fBT; compared with 3.4 cm (1.1,8.5) and 4.1 cm (0.9, 8) in wgBT. These volumes received a median PTV V100 of 98% in fBT and 100% in wgBT. The median dose D0.5 cc in fBT compared to wgBT was 8.4 Gy vs. 9.5 Gy for the urethra, 5.4 Gy vs.7 Gy bladder and 8.6 Gy vs. 7.3 Gy rectum. The 5-year biochemical control was 45.2% (95% CI 31.5, 64.9). There was no grade 3 toxicity. In the fBT group 23 (62%) patients had grade 1 genitourinary toxicity, and 2 (5%) grade 2; compared with 5 (38%) and 8 (62%) in the wgBT cohort, respectively. Grade 1 gastrointestinal toxicity developed in 4 (11%) with no grade 2 after fBT, whereas in the wgBT, 4 (31%) and 3 (23%) reported grade 1 and grade 2 gastrointestinal toxicity. A minority of 17 (34%) men had adequate sexual function before salvage BT of whom 6 (35%) developed grade 1 toxicity and 3 (17.6%) developed grade 2 (5 and 1 patient in fBT group, respectively). Scores in QoL demonstrated a decrease at month 1 which recovered by month 3 and was stable for urinary (P < 0.001) and bowel (P = 0.013) while sexual function continued declining during follow-up; with higher scores for fBT compared to wgBT (P = 0.018).Salvage MRgHDRBT was a safe and well-tolerated treatment with minimal adverse effects on urinary and bowel QoL measures but detrimental to sexual QoL. Further analysis with larger sample size might clarify the complex relationship between implant characteristics, dose-volume, toxicity and QoL.

PHYSIOTHERAPEUTIC ACTIVITY IN THE TREATMENT OF PENETRAL GENE PAIN / PENETRATION WITH A FOCUS ON THE MANUAL THERAPY APPROACH IN WOMEN AT MENACME

Genital-pelvic pain / penetration disorder (DGPP) includes vaginismus, dyspareunia and vulvodynia, where the following symptoms are present: Presence of fear or anxiety related to vulvovaginal or pelvic pain in anticipation, during or as a result of vaginal penetration, in addition to the presence of tension or hardening of the pelvic floor muscles during the attempt of vaginal penetration. Adequate sexual function is considered an important factor for quality of life, being recognized by WHO (World Health Organization) regarding the presence of sexual dysfunction as a public health problem, recommending its investigation for causing important changes in quality of life and in the relationship with your partner. It is identified that the role of the physiotherapist becomes relevant in the process of identification and rehabilitation of genito-pelvic pain, justifying the importance of studies on this topic. In order to analyze the role of the physiotherapist in the treatment of pelvic genital pain / penetration with a focus on the approach of manual therapy in women at menacme, a narrative review of the literature was carried out, where 17 articles were used as a basis for research and data collection. During the analysis of the articles, it was defined that DSFs tend to appear in the female fertile phase, causing pain and discomfort. In the reviews covered in this study, it was analyzed that DGPP is a complex syndrome in which the sensation and intensity of pain are felt in different places. With this the diagnosis becomes difficult taking into account the shame and / or blocking of the woman in reporting a sexual complaint. Through a physical therapy assessment, in order to check the tone and function of the pelvic floor muscles, the existence and location of tender points, as well as the understanding of voluntary contractions and rests of these muscles, a therapeutic planning with the use of interventions is outlined. specific measures in self-relaxation and anxiety control techniques, improving body awareness. It is concluded that there is effectiveness in exploring self-knowledge to improve the quality of life of women who suffer from this problem, providing positive results in a short period, thus contributing to the improvement of the sexual function of women with DSFs (Female Sexual Dysfunctions).

Effectiveness of postpartum sexual health education programme structured according to Levine's conservation model: An interventional study.

This study aimed to determine the effects of a postpartum sexual health education programme structured according to Levine's conservation model on postpartum women. The interventional study was completed with 67 postpartum women. The intervention group was given the postpartum sexual health education programme structured according to Levine's conservation model. The control group received routine discharge training. The data were collected using a personal information form, The Index of Female Sexual Function, Arizona Sexual Experience Scale and Golombok-Rust Inventory of Sexual Satisfaction. It has been determined that the decrease in sexual arousal and desire is the first among postpartum sexual problems experienced by women. This study demonstrated that sexual function, sexual satisfaction and sexual response were higher in nonbreastfeeding women, women who had sexual intercourse one to three times a week and women who could talk to health care professionals on sexual matters. After the programme, the intervention group had more adequate sexual function, and they developed a strong, easy and satisfactory sexual response than the control group (p < 0.05). This programme was effective in increasing the sexual functions and satisfaction of the postpartum women. Models provide guidance to nurses for provision of care in a systematic manner.

AB087. Discontinuation of dapoxetine treatment in patients with premature ejaculation: a 2-year prospective observational study

BackgroundAlthough dapoxetine is the only oral pharmacological agent approved for the treatment of premature ejaculation (PE), and is very effective, the discontinuation rate is high. We assessed the discontinuation rate in patients with PE, and the reasons for discontinuation, in real-world practice.MethodsA total of 182 consecutive patients [mean age 38.2 (range, 19–63) years] were enrolled. The type of PE (lifelong or acquired), the self-estimated intravaginal ejaculation latency time (IELT), and medical history were evaluated in all patients, who also completed the International Index of Erectile Function-Erectile Function Domain (IIEF-EFD) questionnaire. Visits were scheduled 1, 3, 6, 12, and 24 months after initiation of therapy; we checked treatment status and the reasons for discontinuation in those who did in fact discontinue. We compared the relationships of discontinuation rates with various parameters and the time to discontinuation after treatment commencement.ResultsOf all patients, 9.9% continued treatment to 2 years. The discontinuation rates at 1, 3, 6, 12, and 24 months were 26.4%, 35.2%, 17.6%, 8.2%, and 2.7%, respectively. Cumulatively, 79.1% of all patients discontinued treatment within 6 months. After 12 months, however, the discontinuation rate fell sharply. The reasons for discontinuation were cost (29.9%), disappointment that PE was not curable and that dapoxetine was required every time sexual intercourse was contemplated (25%), side effects (11.6%), perceived poor efficacy (9.8%), a search for other treatment options (5.5%), and unknown (18.3%). Patients with acquired PE (compared to lifelong PE), with IELT >2 min prior to treatment, on PDE-5 inhibitors, and with IIEF-EF scores <26 tended to discontinue early and thus exhibited high drop-out rates.ConclusionsOnly 9.9% of patients continued treatment to 24 months; 79.1% discontinued within 6 months. The main reasons for discontinuation were the cost and disappointment that treatment was required every time adequate sexual function was required, followed by side effects and perceived poor efficacy. These results indicate that a better strategy is required to manage PE patients.

Discontinuation of Dapoxetine Treatment in Patients With Premature Ejaculation: A 2-Year Prospective Observational Study.

IntroductionAlthough dapoxetine is the only oral pharmacologic agent approved for the treatment of premature ejaculation (PE) and is very effective, the discontinuation rate is high.AimTo assess the discontinuation rate of patients with PE and the reasons for discontinuation in real-world practice.MethodsIn total, 182 consecutive patients were enrolled. Type of PE, self-estimated intravaginal ejaculation latency time, and medical history were evaluated in all patients who also completed the erectile function domain of the International Index of Erectile Function (IIEF). Visits were scheduled 1, 3, 6, 12, and 24 months after initiation of therapy; treatment status and the reasons for discontinuation in those who did discontinue were checked. The relations of discontinuation rates were compared with various parameters and the time to discontinuation after treatment commencement.ResultsOf all patients, 9.9% continued treatment to 2 years. The cumulative discontinuation rates at 1, 3, 6, 12, and 24 months were 26.4%, 61.6%, 79.1%, 87.3%, and 90.1%, respectively. Moreover, 79.1% of all patients discontinued treatment within 6 months. After 12 months, the discontinuation rate decreased sharply. The reasons for discontinuation were cost (29.9%), disappointment that PE was not curable and that dapoxetine was required every time sexual intercourse was contemplated (25%), side effects (11.6%), perceived poor efficacy (9.8%), a search for other treatment options (5.5%), and unknown (18.3%). Patients with acquired PE (vs lifelong PE), with intravaginal ejaculation latency time longer than 2 minutes before treatment, on phosphodiesterase type 5 inhibitors, and with IIEF erectile function scores lower than 26 tended to discontinue early and thus exhibited high dropout rates.ConclusionThe treatment discontinuation rate of dapoxetine was very high. The main reasons for discontinuation were the cost and disappointment that treatment was required every time adequate sexual function was required.Park HJ, Park NC, Kim TN, et al. Discontinuation of Dapoxetine Treatment in Patients With Premature Ejaculation: A 2-Year Prospective Observational Study. Sex Med 2017;5:e99–e105.

PD57-10 A PROSPECTIVE STUDY ON THE IMPACT OF RADICAL CYSTECTOMY ON SEXUAL FUNCTION IN FEMALES WITH BLADDER CANCER

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation III1 Apr 2017PD57-10 A PROSPECTIVE STUDY ON THE IMPACT OF RADICAL CYSTECTOMY ON SEXUAL FUNCTION IN FEMALES WITH BLADDER CANCER Karim Marzouk, Bruce Rapkin, Yuelin Li, Thomas Atkinson, Alan Thong, Leah Goldstein, Dahlia Sperling, Carolyn Schwartz, Harry Herr, Machele Donat, Vincent Laudone, Jonathan Coleman, Guido Dalbagni, and Bernard Bochner Karim MarzoukKarim Marzouk More articles by this author , Bruce RapkinBruce Rapkin More articles by this author , Yuelin LiYuelin Li More articles by this author , Thomas AtkinsonThomas Atkinson More articles by this author , Alan ThongAlan Thong More articles by this author , Leah GoldsteinLeah Goldstein More articles by this author , Dahlia SperlingDahlia Sperling More articles by this author , Carolyn SchwartzCarolyn Schwartz More articles by this author , Harry HerrHarry Herr More articles by this author , Machele DonatMachele Donat More articles by this author , Vincent LaudoneVincent Laudone More articles by this author , Jonathan ColemanJonathan Coleman More articles by this author , Guido DalbagniGuido Dalbagni More articles by this author , and Bernard BochnerBernard Bochner More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2612AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patient reports of health related quality of life (HRQoL) are being used to facilitate understanding of the physical and psychological impacts of surgery in patients with bladder cancer. Presently, the true effect of radical cystectomy (RC) on female sexual function is poorly described. The aim of this study is to prospectively report baseline and post-operative sexual function in a group of females undergoing RC. METHODS Seventy-four females undergoing RC for bladder cancer were enrolled from 2008-2014 in a prospective HRQoL study. The Female Sexual Function Index (FSFI) was administered 1 month prior to RC, 6- and 12-months post-operatively. Latent Transition Analysis (LTA) was conducted at all 3 points in time to assign patients to homogeneous groups based on their survey responses (i.e., patients with similar responses were grouped together). Group membership was modeled by marital status, type of urinary diversion, vaginal reconstruction, and administration of neoadjuvant chemotherapy. LTA was also used to estimate transitions between groups over time. RESULTS Sixty patients completed baseline surveys and 47 (64%) one year following cystectomy. Median age of the cohort was 66 (IQR 59,72) and 62 patients (84%) underwent vaginal reconstruction with RC. LTA revealed that at baseline, 65% of patients provided responses that were characterized as having ′no sexual activity′ (group 1), 17% ′limited sexual function′ (group 2), and 18% ′adequate sexual function′ (group 3). The distributions were stable one year after RC (65%, 21%, and 14% for the 3 groups, respectively). Analyzing transitions between preop grouping and at 1 year revealed that 44% of patients with adequate sexual function (group 3) remained unchanged. In group 2, 33% remained in the same category, while 21% transitioned to group 3. For patients reporting no sexual activity pre-op, 87% remained in the same category at 1 year, but 8% and 5% transitioned to groups 2 & 3 respectively. Being married was significantly associated with sexual function after surgery (p<0.001). No significant association was found based on the type of urinary diversion, vaginal reconstruction, or neoadjuvant chemotherapy. CONCLUSIONS Although a large proportion of females are not sexually active either before or after RC, one third of patients in this study maintained sexual function, with a small proportion demonstrating improvement at 1 year. Enhanced understanding of pre-op and post-op sexual function can lead to improved peri-operative counseling & surgical planning for sexually active females undergoing RC. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1125 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Karim Marzouk More articles by this author Bruce Rapkin More articles by this author Yuelin Li More articles by this author Thomas Atkinson More articles by this author Alan Thong More articles by this author Leah Goldstein More articles by this author Dahlia Sperling More articles by this author Carolyn Schwartz More articles by this author Harry Herr More articles by this author Machele Donat More articles by this author Vincent Laudone More articles by this author Jonathan Coleman More articles by this author Guido Dalbagni More articles by this author Bernard Bochner More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Clinical Practice Guidelines for Management of Sexual Dysfunction

Sexual functioning is a complex bio-psycho-social process, coordinated by the neurological, vascular and endocrine systems. In addition to the biological factors, the psychosocial factors like societal and religious beliefs, health status, personal experience, ethnicity and socio-demographic conditions, and psychological status of the person/couple play an important role in adequate sexual functioning of a person. In addition, sexual activity incorporates interpersonal relationships, each partner bringing unique attitudes, needs and responses into the coupling. A breakdown in any of these areas may lead to sexual dysfunction. Prevalence of sexual dysfunction in general population is very high. It is suggested that about 43% of women and 31% of men have one or other kind of sexual dysfunction. Among men, premature ejaculation is the most common male sexual dysfunction. There is lack of consensus with regards to the most common sexual dysfunction in women with some studies reporting hypoactive sexual desire disorder to be the most common entity, followed by orgasmic and arousal disorders; whereas other studies suggest that difficulty achieving orgasm and vaginal dryness to be the most common type of sexual dysfunction in women. Problems of sexual dysfunction may be lifelong or acquired, general or situational. Although sexual problems are highly prevalent, these are frequently under-recognized and under-diagnosed in clinical practice. It is also noted that clinicians also have lack of understanding about the approach for identification and evaluation of sexual problem. It is often recommended that the treating psychiatrists and collaborating specialists need to possess broad knowledge and appropriate attitude towards human sexuality. The essential concepts underlying the management of sexual problems are adoption of a patient-centered framework for evaluation and treatment. Principles of evidence-based medicine may be followed in both men and women in diagnostic and treatment planning and adoption of common management approaches for sexual dysfunction. The purpose of these guidelines is to present a framework for the evaluation, treatment, and follow-up of the patient/couple, who presents with sexual dysfunction. We hope that these guidelines would help in facilitating proper management of patients presenting with various types of sexual dysfunction. These guidelines are to be read along with the earlier version of Indian Psychiatric Society Guidelines.

Função sexual e qualidade de vida de mulheres: um estudo observacional

Objective: To compare the relationship between sexual function and quality of life (QOL) in women. Type of study: Cross-sectional study. Setting: Bahia, Brazil Participants: High school educated women who were members of a fitness club. Methods: Sexually active non-pregnant women between 18 and 60 years of age were invited to participate in this study. A questionnaire on sociodemographic and clinical information was administered along with the Female Sexual Function Index. Quality of life was evaluated using the SF-36 questionnaire. SF-36 scores of women with and without sexual were compared using the independent t test. Results: The sample included 375 physically active women with a mean age of 34.6±10.0 years. Sexual dysfunction was found in 21.1%. In all domains of the SF-36 women with dysfunction had lower mean scores (p < = 0.01 for emotional aspects and p < 0.01 for other domains). We observed differences in mean scores in mental health, physical, emotional aspects and social aspects respectively, (59.6±18.7), (72.6±33.1), (67.1±38.7) and (69.2±22.8) for women with sexual dysfunction and in the median scores (72.1±16.8), (85.1±26.6), (78.6±34.4) and (80.7±21.9) for women with adequate sexual function (p < 0,01 for all). Conclusion: Sexual Dysfunction had a negative impact on QOL in women in this population.

Case Report: Long Term Follow Up of Bladder Exstrophy Repaired in Stages with Complete Urinary Continence

Bladder exstrophy is a rare congenital anomaly displaying symptoms such as the urinary bladder turned inside out, an exposed dorsal urethra, foreshortened penis, anteriorly displaced anus and widely separated symphysis pubis. This abnormality is managed by many methods, one of which includes a functional reconstruction. Themajor goals of surgical intervention are: Preservation of the renal function, achieving urinary continence with adequate sexual function and acceptable cosmetic appearance. In this report we present a long term follow up (25 years) of a male patient with classical type bladder exstrophy, managed at our hospital in stages, he is fully continent and voids spontaneously without clean intermittent self-catheterization, with normal renal function, adequate penile erection and has ejaculation.

Feminizing genitoplasty in congenital adrenal hyperplasia: A new method for clitoral reduction

Background: Congenital adrenal hyperplasia (CAH) is a disorder wherein female babies are born with masculinized external genitalia characterized by hyperpigmented or fused labioscrotal tissue, a urogenital sinus, and clitoromegaly. Feminizing genitoplasty (clitoroplasty, labioplasty, and vaginoplasty) is necessary to make the patient consistent with gender identity and to ensure adequate sexual function in pubertal age. Patients and Method: We performed feminizing genitoplasty in which reduction clitoroplasty was done by a ventral approach in 6 patients of CAH, with a mean age of 3.8 years. Excessive erectile tissue was excised by giving incisions into Buck's fascia at 8 and 4 o'clock position on the clitoral shaft and Byar's flaps created from the degloved clitoral shaft were used for labial and vaginal reconstruction. The glans clitoris was left as such and anchored to proximal 1–1.5 cm clitoral shaft. Results: All patients had good cosmetic female appearance of external genitalia. In 5 patients, the clitoroplasty was done along with labioplasty and vaginal introitus exteriorization. However, in 1 patient, the vaginal confluence into urogenital sinus was high and hence only clitoral reduction as well as labioplasty was done and the urogenital sinus opening was left as such. The maximum follow-up is up to 6 years with good result. Conclusion: The reduction clitoroplasty by present approach of 8 and 4 o'clock incision into the Buck's fascia is a good option for clitoral girth and length reduction as it preserves approximately two-third of Buck's fascia with intact neuromuscular bundle and glans. Postoperatively, patients have good vascularity and sensation of the glans clitoris and acceptable cosmetic outcome. However, the long-term results are difficult to comment as no patient of the present study achieved puberty.

Impaired Testicular Function After an Ifosfamide-containing Regimen for Pediatric Osteosarcoma

To assess testicular function after standard dose ifosfamide, we evaluated 6 young adult osteosarcoma survivors (median age at diagnosis, 16.5 y; median follow-up, 4 y) treated with ifosfamide (median dose, 45.5 g/m) as part of a chemotherapy regimen (adriamycin/cisplatin/methotrexate/ifosfamide/± muramyl-tripeptide-phosphatidyl-ethanolamine). Four of 6 survivors (67%) had abnormal semen analysis (2 oligospermic, 2 azoospermic). Of those, 1/4 had reduced testicular volume, and 2/3 elevated FSH levels. All reported adequate sexual function, 6/6 had normal testosterone levels, but 4/6 had elevated LH levels. Ifosfamide exposure in the context of this regimen was associated with a high likelihood of impaired spermatogenesis and Leydig cell insufficiency.

165 LIVE BETTER: THE EFFECT OF LIFESTYLE BEHAVIORS ON POST-PROSTATECTOMY HEALTH RELATED QUALITY OF LIFE OUTCOMES

You have accessJournal of UrologyProstate Cancer: Epidemiology and Natural History I1 Apr 2012165 LIVE BETTER: THE EFFECT OF LIFESTYLE BEHAVIORS ON POST-PROSTATECTOMY HEALTH RELATED QUALITY OF LIFE OUTCOMES Michael A. Poch, Diana C. Mehedint, Rebecca L. O'Malley, Chi-Chen Hong, Levi Ross, Khurshid A. Guru, and Willie Underwood Michael A. PochMichael A. Poch Buffalo, NY More articles by this author , Diana C. MehedintDiana C. Mehedint Buffalo, NY More articles by this author , Rebecca L. O'MalleyRebecca L. O'Malley Buffalo, NY More articles by this author , Chi-Chen HongChi-Chen Hong Buffalo, NY More articles by this author , Levi RossLevi Ross Buffalo, NY More articles by this author , Khurshid A. GuruKhurshid A. Guru Buffalo, NY More articles by this author , and Willie UnderwoodWillie Underwood Buffalo, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.216AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Modifiable lifestyle behaviors, including tobacco use, alcohol consumption, and physical activity, have been shown to affect genitourinary health in men. The goal of this study was to assess the impact of lifestyle behaviors on health-related quality of life (HRQL) outcomes for patients undergoing robotic radical prostatectomy (RARP) using a novel composite index: Lifestyle Index of Vascular and Erectile health (LIVE score). METHODS The prospective IRB approved localized prostate cancer database at Roswell Park Cancer Institute was queried for patients who underwent RARP from 2004 to 2009. HRQL outcomes were measured using the UCLA-PCI at standard postoperative time points. Lifestyle behavior data were obtained from the Institutional Data Bank and BioRepository which collects extensive epidemiological information regarding dietary, social, and health practices at the time of cancer diagnosis. LIVE scores were generated by assigning values to smoking status, pack year history, physical activity level and body mass index (BMI). Patients with LIVE scores ≤ 2 were categorized as low, 3-4 average, and >4 high. The relationship between LIVE scores and HRQOL outcomes was assessed using ANOVA and multivariable regression analysis. RESULTS 409 patients were included in the study. Mean age at operation was 60 (SD ± 6 years) with mean pre-operative PSA 6.5 ng/ml (SD ± 5.1). 130 (32%) patients reported adequate sexual function by 12 months postoperatively. 179(44%) patients returned to baseline sexual bother score by 12 months. At 6 months 359 (88%) patients were using ≤2 pads per day and (217) 53% had perfect continence. Urinary bother scores returned to baseline in 219 (53%) patients by 12 months. 77 (19%), 246 (60%) and 73 (18%) patients had high, average and low LIVE scores, respectively. Patients with average and high LIVE scores had higher sexual function scores than patients with low LIVE scores preoperatively (p <0.001), at 6 (p = 0.01), 12 (p = 0.013) and 24 months (p = 0.036). Better erection quality (p = 0.02) and orgasmic function (p = 0.01) were positively associated with LIVE scores after adjustments for age, preoperative sexual function, and receipt of nerve sparing technique. There was no difference in pad count between LIVE groups at 6 and 12 months after adjustment for age and nerve-sparing technique. CONCLUSIONS As demonstrated by the LIVE index, healthy lifestyle behaviors are associated with improved postoperative sexual function for patients undergoing RARP. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e68-e69 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael A. Poch Buffalo, NY More articles by this author Diana C. Mehedint Buffalo, NY More articles by this author Rebecca L. O'Malley Buffalo, NY More articles by this author Chi-Chen Hong Buffalo, NY More articles by this author Levi Ross Buffalo, NY More articles by this author Khurshid A. Guru Buffalo, NY More articles by this author Willie Underwood Buffalo, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Androgens are Fundamental in the Maintenance of Male Sexual Health

The presence of a sufficient amount of androgens is essential for adequate sexual function in men. Gonadal hormones profoundly affect cognitive functions and, therefore, are fundamental in maintaining sexual desire. The earliest manifestation of hypogonadism is diminished libido. Furthermore, androgens also act peripherally, maintaining the integrity of penile structures and facilitating the erectile mechanisms. Severe androgen deficiency results in anatomical and hemodynamic changes leading to erectile dysfunction that can be corrected with testosterone supplementation.

Micropenis

Micropenis is part of a larger group of conditions broadly known as inconspicuous penis; however, it is fundamentally different from the other diagnoses in this group, such as webbed penis and buried penis, in that the underlying problem is the size of the penis itself, not with the surrounding and overlying skin. This condition is usually the result of a defect in the hypothalamic-pituitary-gonadal axis, although iatrogenic causes are identified infrequently. Management revolves around testosterone (direct administration or encouraging the patient's body to make its own), and long-term results with respect to increase in penile length are promising. Reconstructive surgery is based on the use of a vascular pedicle free flap and is reserved for patients who fail to respond to hormonal treatment. Although substantial long-term data are lacking, adult patients with micropenis appear to report dissatisfaction with penile appearance, but the majority appear to have adequate sexual function.

Sexual function and fertility issues in cases of exstrophy epispadias complex

In patients with EEC, the issues such as sexuality, sexual function and fertility gain more importance once theses patients advance from puberty to adulthood. The aim of this review is to critically examine the available evidence on these issues. A systemic literature search was performed in Medline over the last 25 years using the key words: Exstrophy, sexual function and pregnancy. Search results were limited to studies of patients with exstrophy published in English literature. A total of 1500 publications were found and subsequently screened by title and when appropriate by abstracts. Of these, 40 publications pertinent to the subject were included for the analysis. The publications were supplemented by an additional 15 publications obtained from their bibliographies. The studies were rated according to the guidelines published by the US department of health and human services. Heterosexuality is usually expressed in both the sexes and most of them have adequate sexual function. Urinary diversion in some series seems to result in better ejaculatory hence fertility outcome in male patients. Recent series have shown equally good results with primary reconstruction. Most of the female patients have normal fertility while male patients have significantly low fertility. Most of the male and female patients with EEC have adequate sexual function. Most of the female patients have normal fertility while most of the male patients have significantly low fertility.