Patient-reported Sexual Function Research Articles

Patient-Reported Sexual Function following Proton Therapy for Prostate Cancer in Men Age ≤ 60 Years

Patient-Reported Sexual Function following Proton Therapy for Prostate Cancer in Men Age ≤ 60 Years

Does one have a sexual life 15 years after external beam radiotherapy for prostate cancer? Prospective patient-reported outcome of sexual function comparison with age-matched controls

Background and purpose We previously published research on 4- and 8-year follow-ups of patient-reported sexual function after conventional external beam radiotherapy (EBRT) for localized prostate cancer (LPC) compared with age-matched controls. The current study is a prolonged 15-year follow-up with the same cohorts. Material and methods The cohort consisted of 29 men surviving from a group of 181 men treated between 1986 and 1989, and who were reported on previously. Of the originally reported 141 controls, 62 were eligible and 34 completed the questionnaires. Sexual function was assessed using two questionnaires, Prostate Cancer Symptom Scale (PCSS) and International Index of Erectile Function (IIEF-5). Results Twenty-three patients (78%) and 13 controls (38%) were not sexually active. None of the patients and 14 controls had enough of an erection to perform intercourse. Seventeen patients (94%) and 14 controls (64%) had severe erectile dysfunction. Patients with clinical progression and who had received hormone treatment had decreased sexual desire. No significant differences were measured between patients without progression/hormone treatment and the controls. Conclusion The sexual activity 15 years after EBRT for LPC was very low, as was the probability of achieving an erection. Patients with a progressive disease and treated with hormones reported worse sexual and erectile function. The LPC free men showed higher sexual activity, lower sexual bother, and better erectile function than the patients.

The Effect of Bulbar Urethroplasty on Erectile Function

Theoretically bulbar urethroplasty has the potential to adversely affect potency, involving as it does dissection in proximity to the corporeal bodies and erectile neurovascular structures. We prospectively examined the effect of various bulbar urethroplasties on erectile function. Prior to undergoing urethroplasty, patients completed an International Index of Erectile Function questionnaire. Each patient repeated the International Index of Erectile Function at least 3 months postoperatively. One-sided t and Fisher's exact tests were used to compare preoperative and postoperative erectile function. A total of 25 men with an average age of 39 years (range 26 to 66) completed the study. Etiology of stricture was idiopathic in 20 patients and traumatic in 5. Stricture location was panbulbar in 5 patients, mid to posterior bulbar in 13 and mid to distal bulbar in 7. Eight men underwent anastomotic urethroplasty, 15 underwent augmented anastomotic repair using a buccal mucosal graft and 2 underwent a dorsal onlay. At a mean of 6.2 months of followup, average total International Index of Erectile Function went from 62.6 to 59.6 of 75 possible points and the average erectile function domain score went from 26.9 to 24.8 of 30 possible points. Neither of these differences attained significance (p = 0.29 and 0.13, respectively). A total of 25 men had an erectile function domain postoperative score of greater than 20 and 8 had a score of 20 or less. Men with a score of 20 or less were older (47 vs 36.8 years, p = 0.17) and had worse preoperative erectile function (20 vs 29, p = 0.11) than those with erectile function scores greater than 20, although these differences did not achieve significance. We report on men undergoing 4 variations of bulbar urethroplasty. Although the numbers are small, we found that such surgery had an insignificant effect on erectile function. Surgical complexity with long stricture excision and the use of a buccal graft did not influence outcome.

Patient-reported Sexual Function After Oral Mucosa Graft Urethroplasty for Hypospadias

Objectives To evaluate sexual function after oral mucosa graft urethroplasty (OMGU) for hypospadias. Few long-term patient-reported data are available regarding sexual function after surgery for hypospadias. Methods We identified patients aged 18 years or older at the time of this survey who had undergone OMGU for hypospadias between 1992 and 2003. We evaluated sexual function and satisfaction using the 15-item International Index of Erectile Function (IIEF-15). Results Of the 16 adult patients, we located 14, of whom 11 (79%) participated. Previous hypospadias repair had failed in all 11 before OMGU. The median age at OMGU was 17.5 years. The median follow-up time was 4.7 years. Of the 10 sexually active patients, the mean score on the IIEF-15 was 64.6 ± 11.9 (maximal possible score 75). Erectile function was excellent, with all 10 able to achieve an erection most or all of the time (mean erection domain score 26.8 ± 6.1). All 10 experienced sensation of orgasm most or all the time, although 1 never ejaculated and 2 ejaculated rarely (mean orgasm domain score 8.9 ± 1.8). All 10 reported that they were moderately (n = 6) or very (n = 4) satisfied with their overall sex life (mean satisfaction domain score 8.3 ± 1.9). Neither occurrence of post-OMGU complications nor satisfaction with penile appearance was significantly associated with the IIEF-15 scores or overall sexual satisfaction. Conclusions Long-term sexual function and satisfaction was excellent in these patients after OMGU for hypospadias. Adolescent boys and men with failed hypospadias repairs, as well as parents of boys with hypospadias, can be counseled that most patients who undergo OMGU are likely to have satisfactory sexual function as adults.

Editorial comment

The authors have assessed patient-reported sexual function in those men who have undergone buccal mucosa graft urethroplasty. Most reports of patients who have undergone buccal mucosa graft repairs have focused on the overall surgical success rate from a cosmetic and overall complication and reoperative rate. Increasingly, functional assessment of those patients will be necessary to determine overall success, as well as the durability, of these procedures. This is one of the first attempts to assess patients from a sexual standpoint.

812: Patient-Reported Sexual Function after Oral Mucosa Graft Urethroplasty for Hypospadias

You have accessJournal of UrologyModerated Poster, Monday, May 23, 2005, 1:00 - 3:00 pm1 Apr 2005812: Patient-Reported Sexual Function after Oral Mucosa Graft Urethroplasty for Hypospadias Caleb P. Nelson, David A. Bloom, Robert Kinast, John T. Wei, and John M. Park Caleb P. NelsonCaleb P. Nelson More articles by this author , David A. BloomDavid A. Bloom More articles by this author , Robert KinastRobert Kinast More articles by this author , John T. WeiJohn T. Wei More articles by this author , and John M. ParkJohn M. Park More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)34981-4AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "812: Patient-Reported Sexual Function after Oral Mucosa Graft Urethroplasty for Hypospadias." The Journal of Urology, 173(4S), p. 220 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 173Issue 4SApril 2005Page: 220 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Caleb P. Nelson More articles by this author David A. Bloom More articles by this author Robert Kinast More articles by this author John T. Wei More articles by this author John M. Park More articles by this author Expand All Advertisement PDF downloadLoading ...

Neoadjuvant hormonal therapy impairs sexual outcome among younger men who undergo external beam radiotherapy for localized prostate cancer

Objectives To evaluate the effects of treatment factors and other covariates on sexual health-related quality of life (HRQOL) after radiotherapy (RT) for prostate cancer. The effects of clinical and treatment factors on sexual health after external beam RT have not been fully characterized by patient-reported, validated questionnaires. Methods A total of 259 subjects (147 patients who had undergone RT for prostate cancer and 112 age-matched controls) participated in a cross-sectional assessment of HRQOL using the validated expanded prostate cancer index to measure patient-reported sexual function and bother. Multivariable models were used to determine the association of 13 prospectively measured clinical and treatment factors with post-RT sexual HRQOL. Results Increasing age, time since RT, and use of neoadjuvant hormonal therapy (NHT) were independently associated with sexual function ( P <0.01) after RT. The effects of NHT on sexual HRQOL were most notable among the youngest (younger than 67 years) patients and among those closest to treatment. These effects may be conceptualized by examining the distribution of responses to individual Expanded Prostate Cancer Index Composite questions. For example, among the youngest patients, those treated with NHT were less than half as likely to report a fair ability to have erections compared with hormone-naive men. Conclusions These patient-reported data, elicited using a validated HRQOL instrument, indicate that older age and NHT significantly and independently hinder post-RT sexual HRQOL outcome among men with localized prostate cancer and provide a framework for counseling patients regarding long-term sexual outcome on the basis of treatment plan and age.