Postoperative Sexual Function Research Articles

The Effect of Vaginal Tightening Surgery on Sexual Function: A Systematic Review.

Lifetime physiological or pathological events, such as vaginal delivery and menopause, may change vaginal structure and appearance, owing to local tissue expansion and separation of the pelvic floor muscles, which can affect a woman's sexual relationships. This systematic review was aimed at exploring the effect of vaginal tightening surgery on female sexual function. Articles that had measured female sexual function after vaginal tightening were considered eligible. Articles on vaginal tightening surgeries conducted only for cosmetic and/or sexual and/or functional reasons (not for medical indications) and which evaluated postoperative sexual function by a quantitative tool were included. A literature review was conducted by searching databases such as PubMed, Web of Science, Scopus, PsycINFO, Embase, the Cochrane Library, and ClinicalTrials.gov from the beginning of 2000 until 1 February 2024. The authors identified 11 studies that had evaluated sexual function after vaginal reconstructive procedures designed to adjudicate sexual issues involving loss of friction, orgasmic, and aesthetic concerns. Although most of the studies implied that vaginal tightening could improve sexual function, more meticulous assessment of the studies' methodology challenged the robustness of these findings in clinical decision making. Although on the surface, it can be concluded that vaginal tightening surgery improves women's sexual function, the conclusion is severely restricted owing to the absence of the precise measurement of vaginal laxity, as well as the inconsistency in surgical techniques, methods, and tools employed in the research.

Timing of puberty suppression in transgender adolescents and sexual functioning after vaginoplasty.

Sexual function in transgender adolescents after puberty suppression has been a topic of recent clinical and scientific questions. This study aimed to explore the long-term effects of early treatment with puberty suppression on sexual functioning of transfeminine individuals after vaginoplasty. This retrospective cohort study included 37 transfeminine individuals treated with a gonadotropin-releasing hormone agonist (puberty suppression), estrogen, and vaginoplasty (penile inversion technique or intestinal vaginoplasty) at the Center of Expertise on Gender Dysphoria in Amsterdam, the Netherlands, between 2000 and 2016. Experiences regarding sexual functioning and difficulties were assessed with a self-developed questionnaire ~1.5years after genital gender-affirming surgery and compared between early (Tanner stage G2-3) and late (Tanner stage G4-5) treatment with puberty suppression. Following surgery, 91% of transfeminine individuals was able to experience sexual desire, 86% experienced arousal, and 78% could attain an orgasm. Seventy-five percent of transfeminine individuals who had not experienced an orgasm pre-surgery were able to experience one post-surgery. Of all participants, 62% reported having tried penile-vaginal intercourse post-surgery. The majority reported the presence of one or multiple sexual challenges. There were no significant differences in postoperative sexual function or sexual difficulties between groups treated with early versus late puberty suppression. With these findings, more adequate and tailored information on the expected effects of early endocrine gender-affirming treatment (including puberty suppression) can be given by healthcare professionals. This is the first study that has assessed sexual functioning of transgender individuals treated with puberty suppression, and has differentiated between the pubertal stage at treatment initiation. Limitations were the small cohort size and retrospective study design. This study focuses on sexual functioning, however, it is important to realize sexual wellbeing is multifactorial and encompasses more than genital functioning or the ability to have certain sexual experiences. This study found that post-vaginoplasty transfeminine individuals after both early and late suppression of puberty have the ability to experience sexual desire and arousal, and to achieve orgasms. Outcomes are comparable to previous findings in those who started treatment in adulthood.

To Preserve or Not To Preserve: A Prospective Cohort Study on the Role of the Cervix in Post-Hysterectomy Sexual Functioning.

Background Hysterectomy remains the most commonly performed gynecologic procedure worldwide, undertaken primarily for benign pathologies. The choice between total hysterectomy (TH) and subtotal hysterectomy (STH) has been debated, particularly with respect to its impact on sexual functioning (SF). Objective This study aimed to assess the impact of TH versus STH on SF and to determine whether preservation of the cervix in STH offers advantages in terms of postoperative SF. Methods A prospective cohort study was conducted at Ibn El Jazzar University Hospital, Kairouan, Tunisia, involving women aged 40 to 65 years who underwent hysterectomy for benign conditions between January 2, 2020, and December 31, 2021. SF was evaluated using the Arizona Sexual Experiences Scale (ASEX) and the Female Sexual Function Index (FSFI) before and six months after surgery. Statistical analyses were performed using SPSS version 26. Results Sixty women were included, with 30 undergoing TH and 30 undergoing STH. Postoperative evaluations revealed improvements in SF in both groups without statistically significant differences between TH and STH in terms of SF scores or the timeline for resuming sexual activity. Conclusions Hysterectomy, regardless of the technique used, appears to have a positive impact on SF, largely attributed to symptomatic relief. Therefore, the choice between TH and STH should consider factors beyond potential differences in SF outcomes. Women considering hysterectomy for benign indications should be informed of these findings to aid in the decision-making process regarding their surgical options.

Minimally Invasive Sacrocolpopexy: Impact on Sexual Function.

Sacrocolpopexy (SCP) is the gold standard surgical management of apical pelvic organ prolapse (POP), and increasingly, minimally invasive SCP is being adopted as a primary treatment for advanced uterovaginal prolapse. Patients undergoing surgery for POP consider postoperative improvement in sexual function to be a highly important outcome, and sexual dysfunction and dyspareunia severe adverse events. Therefore, it is crucial to understand the impact of minimally invasive SCP on postoperative sexual function. We aimed to analyze the current literature available to discuss the impact of minimally invasive SCP on postoperative sexual function. We performed a narrative review of minimally invasive SCP and its impact on sexual function. PubMed and EMBASE were searched from inception through 28 January 2024 for studies that reported sexual function following surgery for POP. Baseline and postoperative sexual activity, dyspareunia, and validated questionnaire scores for sexual function were documented. Minimally invasive SCP is associated with improved postoperative sexual function, increased rates of postoperative sexual activity, and low rates of dyspareunia. Dyspareunia was not associated with mesh related complications. Patients with baseline dyspareunia or pain were more likely to experience persistent dyspareunia after surgery. The rates of POP are increasing in our aging population, and sexual function is very important to patients undergoing surgery for POP. Clinicians should consider all factors related to sexual function when planning surgery for POP and address dyspareunia prior to surgery. Sexual function appears to improve overall after minimally invasive SCP and de novo dyspareunia rates are low.

Comparative outcomes of partial versus total penectomy for penile carcinoma: A retrospective cohort study on demographics and postoperative complications.

When feasible from an oncologic standpoint, partial penectomy (PP) is often preferred to total penectomy (TP) for penile cancer treatment, for the preservation of functional urinary outcomes. However, to date, there has not been a direct comparison of perioperative outcomes between PP and TP. Comparing treatments for penile cancer has proven difficult due to the rarity of penile cancer in the United States. We aimed to report differences in pre-operative risk factors, intra-operative outcomes, and postoperative outcomes between TP and PP for penile cancer. Using the National Surgical Quality Improvement Program database, we conducted a retrospective cohort review of penile cancer patients enlisted in the database between the years 2006-2016 using the International Classification of Diseases clinical modification 9th revision codes. A total of 260 patients, 67 TP and 193 PP patients, were included. PP patients were less likely to be transferred patients (p = 0.002), diabetic (p = 0.026), and were more likely to have preoperative laboratory values within normal limits. PP patients also had shorter lengths of stay in the hospital (p < 0.001) and operating time (p < 0.001). Significant differences were also found for inpatient stay (p < 0.001), 30-day post-surgery complications (p < 0.001), deep incisional surgical site infection (SSI) (p = 0.017), wound disruption (p = 0.017), intraoperative or postoperative transfusion (p = 0.029), and sepsis (p < 0.005). Finally, PP patients required fewer concurrent surgical procedures (p < 0.001). Demographic differences between PP and TP patients may reflect patients presenting with more advanced oncologic disease. PP is associated with fewer postoperative complications, shorter surgeries, shorter hospital stays, fewer concurrent surgical procedures, and comorbid conditions compared to TP. A gap remains in the reported data pertaining to postoperative sexual function and erectile outcomes for PP at a national level.

Preoperative high serum total testosterone levels predict preserved postoperative sexual function in patients after nerve-sparing robot-assisted radical prostatectomy.

To assess the association among preoperative total testosterone levels, postoperative sexual function, and prognosis after robot-assisted radical prostatectomy. Patients who underwent robot-assisted radical prostatectomy in our institution were included in the study. Based on preoperative total testosterone levels, they were divided into low (<3.0 ng/mL) and high (≥3.0 ng/mL) total testosterone groups. Sexual function was evaluated using the International Index of Erectile Function scores, Expanded Prostate Cancer Index Composite scores, and the potency rate from preoperatively to 12 months after surgery. Oncological outcomes were evaluated based on biochemical recurrence. Out of 233 patients included, no significant difference in sexual function was found between the high (n = 183) and the low (n = 50) total testosterone groups at any point before or after surgery. However, in nerve-sparing cases, preservation in postoperative sexual function was observed only in the high total testosterone group (International Index of Erectile Function scores and Expanded Prostate Cancer Index Composite sexual function scores, at any point after surgery, p < 0.05; potency rate, at 3, 6, and 12 months after surgery; p < 0.05). Additionally, the high total testosterone group showed better biochemical recurrence-free survival than the low total testosterone group (p = 0.008). In the high total testosterone group, preservation in sexual function was observed after the nerve-sparing procedure, while the biochemical recurrence rate was low. Therefore, patients with high levels of total testosterone may be advised to consider nerve-sparing interventions.

Beyond the cuff: a consideration of factors that affect sexual function after benign hysterectomy.

Hysterectomy is the most common gynecologic surgical procedure performed on women in the United States. While there are data supporting that hysterectomy for benign indication often does not reduce sexual function and may in fact improve sexual function as fibroids and endometriosis are resected, it remains unclear if there are factors within the perioperative period that affect sexual function in the years following surgery. To date, there is no consensus on what factors can optimize patients' sexual function after hysterectomy. We present the current literature that assesses factors which may contribute to sexual function after hysterectomy. Preoperative demographic factors, including increasing age, pelvic pain, and preoperative sexual dysfunction, play a large role in postoperative sexual function. Perioperatively, there is a growing amount of data suggesting that premenopausal salpingo-oophorectomy at the time of hysterectomy may increase the risk of sexual dysfunction after hysterectomy, and no conclusive evidence that subtotal hysterectomy improves sexual function. The route of hysterectomy and technique of cuff closure can impact sexual function after hysterectomy due to the risk of shortening the vaginal length. There is a lack of high-quality evidence that can provide a consensus on factors to optimize sexual function after hysterectomy. A growing area of research in the excision of endometriosis procedures is the consideration of nerve-sparing surgery. Considering the many variables that exist when counseling a patient on benign hysterectomy and its effects on sexual function, it is critical to understand the current research that exists with regards to these factors.

Self-esteem, depression, anxiety and sexual function in Mayer-Rokitansky-Küster-Hauser syndrome with neovagina: A case series

BackgroundThe Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a rare condition with significant psychological implications. However, our understanding of its impact on postoperative sexual function and mental health is still limited. AimEvaluate the mental health status and sexual functioning of women with MRKH syndrome after vaginoplasty surgery. MethodsWe enrolled 53 cases with MRKH syndrome who underwent artificial vaginoplasty. The participants were asked to participate in a two-round survey conducted between February 2021 during the covid-19 period and March 2023. The survey included questionnaires to measure depression, anxiety, self-esteem, and sexual functioning. Differences between scores over time were analysed using a paired sample t-test, and we assessed the correlation between mental health and sexual functioning. ResultsIn the first round, patients’ mean ± SD age at surgery was 23.6 ± 4.5 years old, and the mean ± SD time that had elapsed since surgery at the time of the survey was 34.2 ± 20.8 months. None of the patients reported low self-esteem, 45.3 % reported mild-to-moderate depression, and 34.0 % reported mild anxiety. Thirty patients have had vaginal intercourse during the last six months. The mean ± SD Female Sexual Functioning Index score was 24.6 ± 4.4, and 60.0 % had a score of 23.5 or higher, indicating high sexual functioning. The sexual functioning scores were positively correlated with self-esteem scores and negatively correlated with depression or anxiety scores (p < 0.05). There was no significant improvement in patient's mental health status and sexual function between the second round survey (71.3 ± 17.8 months after surgery) and the first round survey (p > 0.05). In contrast, the sexual arousal of FSFI were significantly higher in the second survey round (p < 0.05). ConclusionMost patients undergoing vaginoplasty reported persisting mental health challenges. However, the majority reported good sexual functioning.

(239) Postoperative Outcomes and Risk Factors in Patients Receiving Partial vs Total Penectomy for Penile Malignancy

Abstract Introduction Partial penectomies (PP) and total penectomies (TP) are both performed for penile cancer in the United States. Compared to TP, PP is performed more frequently to preserve functional urinary outcomes. To date TP and PP outcomes have not been compared, in this study we compared clinical characteristics and post-operative outcomes between TP and PP conducted between 2006–2016. Objective We conducted a retrospective review of penile cancer patients from National Surgical Quality Improvement Program (NSQIP) database for the years 2010–2016 using international classification of diseases clinical modification (ICD-CM) ninth revision codes. A total of 260 patients, 67 TP and 193 PP patients, were included. Methods We conducted a retrospective review of penile cancer patients from National Surgical Quality Improvement Program (NSQIP) database for the years 2010–2016 using international classification of diseases clinical modification (ICD-CM) ninth revision codes. A total of 260 patients, 67 TP and 193 PP patients, were included. Results Partial penectomy patients were less likely to be transferred patients (7.3% vs 20.9%, p=0.002), less likely to be suffering from diabetes (25.9% vs 40.3%, p=0.026), and were more likely to have preoperative laboratory values within normal limits. TP was associated with increased preoperative white blood cell count x109, preoperative white blood cell count &amp;gt; 7.5x109 (p&amp;lt;0.001), preoperative hematocrit (p&amp;lt;0.001). PP patients were, in contrast, shown to have higher pre-operative creatinine levels (p=.037) and lower platelet levels than TP patients (p=.045). PP patients had shorter operation times (78.8 vs 145.5 min, p&amp;lt;0.001). PP patients also had decreased levels of inpatient stay length (1.67 vs 4.31, p&amp;lt;0.001), any 30-day post-surgery complication (7% vs 31%, p&amp;lt;0.001), deep incisional surgical site infection (0.5% vs 6% p=0.017), wound disruption (0.5% vs 6.0%p=0.017), intraoperative or postoperative transfusion (1.6% vs 7.5%, p=0.029), and sepsis (0.5% vs 7.5%, p=0.005), when compared to patients who underwent TP. TP patients displayed a significantly greater number of concurrent surgical procedures (p&amp;lt;0.001), when compared to PP patients. There was no information on urinary, sexual, and erectile outcomes in the database. Conclusions PP is associated with fewer post-operative complications, shorter surgeries, shorter hospital stays, and fewer concurrent surgical procedures. Total penectomy is associated with a greater proportion of patients suffering from comorbid conditions, suggesting that TP patients are at higher risk for post-surgical complications and longer hospital stays. There is a gap in reported data pertaining to post-operative sexual function and erectile outcomes for PP at a national level. Disclosure No.

(020) Comparing Postoperative Outcomes and Risk Factors for Patients Undergoing Partial vs Total Penectomy for Penile Carcinoma

Abstract Introduction The American Cancer Society estimates that 2,200 men develop penile cancer annually and 440 men will die from the disease. Partial penectomies (PP) and total penectomies (TP) are both performed for penile cancer in the United States. Compared to TP, PP is performed more frequently to preserve functional urinary outcomes. Objective To date TP and PP outcomes have not been compared, in this study we compared clinical characteristics and post-operative outcomes between TP and PP conducted between 2006-2016. Methods We conducted a retrospective review of penile cancer patients from National Surgical Quality Improvement Program (NSQIP) database for the years 2010-2016 using international classification of diseases clinical modification (ICD-CM) ninth revision codes. A total of 260 patients, 67 TP and 193 PP patients, were included. Results Partial penectomy patients were less likely to be transferred patients (7.3% vs 20.9%, p=0.002), less likely to be suffering from diabetes (25.9% vs 40.3%, p=0.026), and were more likely to have preoperative laboratory values within normal limits. TP was associated with increased preoperative white blood cell count x109, preoperative white blood cell count &amp;gt; 7.5x109 (p&amp;lt;0.001), preoperative hematocrit (p&amp;lt;0.001). PP patients were, in contrast, shown to have higher pre-operative creatinine levels (p=.037) and lower platelet levels than TP patients (p=.045). PP patients had shorter operation times (78.8 vs 145.5 min, p&amp;lt;0.001). PP patients also had decreased levels of inpatient stay length (1.67 vs 4.31, p&amp;lt;0.001), any 30-day post-surgery complication (7% vs 31%, p&amp;lt;0.001), deep incisional surgical site infection (0.5% vs 6% p=0.017), wound disruption (0.5% vs 6.0%p=0.017), intraoperative or postoperative transfusion (1.6% vs 7.5%, p=0.029), and sepsis (0.5% vs 7.5%, p=0.005), when compared to patients who underwent TP. TP patients displayed a significantly greater number of concurrent surgical procedures (p&amp;lt;0.001), when compared to PP patients. There was no information on urinary, sexual, and erectile outcomes in the database. Conclusions PP is associated with fewer post-operative complications, shorter surgeries, shorter hospital stays, and fewer concurrent surgical procedures. Total penectomy is associated with a greater proportion of patients suffering from comorbid conditions, suggesting that TP patients are at higher risk for post-surgical complications and longer hospital stays. There is a gap in reported data pertaining to post-operative sexual function and erectile outcomes for PP at a national level. Disclosure No.

Modified Internal Pudendal Artery Perforator Flap Interposition for Rectovaginal Fistula.

Rectovaginal fistula (RVF) is a challenging condition associated with recurrences and significant functional impairment. The internal pudendal artery perforator (IPAP) flap has become a viable option for reconstructing the vagina and perineal regions. This study aims to introduce a modified technique of IPAP flap interposition and evaluate its postoperative outcomes in the treatment of low RVF. Sixteen patients with RVF who underwent modified IPAP flap interposition between 2016 and 2021 were retrospectively enrolled. Recurrence rate, the satisfaction of vulvar appearance (Visual Analog Scale), and quality of sexual life (Female Sexual Function Index score) were followed up and analyzed. All patients presented with low fistula with a mean diameter of 8.3 mm. The mean width and length of the IPAP flaps were 3.8 and 6.2 cm, respectively. The mean follow-up period was 14.1 months. All patients achieved successful healing without recurrence. High satisfaction was reported for the cosmetic effect of the vulva with a mean Visual Analog Scale score of 8.4. The proportion of female sexual disorder exhibited a statistically significant reduction, decreasing from 100% preoperatively to 38% after surgery ( P < 0.05). The modified IPAP flap interposition is a reliable and safe option for repairing low RVF, with high success rates and minimal donor site morbidity. Moreover, this procedure provides a suitable volume flap and preserves the vaginal physiological environment, which benefits postoperative sexual function.

Impact of postoperative sexual function on health-related quality of life after robot-assisted radical prostatectomy.

We investigated potential disparities in health-related quality of life, particularly concerning urinary function, between patients with preserved and those with impaired sexual function after robot-assisted radical prostatectomy (RARP). Between December 2012 and April 2020, 704 men underwent RARP in our hospital. This study included 155 patients with a preoperative 5-item International Index of Erectile Function (IIEF-5) of ≥12 points and an assessable IIEF-5 at 12 months postoperatively. Health-related quality of life was assessed using the 8-item Short-Form Health Survey and Expanded Prostate Cancer Index Composite (EPIC) preoperatively and at 3, 6, and 12 months postoperatively. A logistic regression analysis and Wilcoxon rank sum tests were performed. Patients were grouped according to the median IIEF-5 score 12 months after surgery: those with preserved sexual function (n = 71) and those with impaired sexual function (n = 84). The mental component summary of the 8-item Short-Form Health Survey was better in the group with preserved sexual function at 6 months postoperatively than in the group with impaired sexual function (p < 0.01). In the EPIC, the group with preserved sexual function performed better not only in the sexual domain but also in the urinary domain at all time points compared with the group with impaired sexual function (p < 0.01). In the comparison of the urinary subdomains of the EPIC, there were no significant differences in urinary function or incontinence, but there were significant differences in urinary distress and irritative/obstructive scores (p < 0.01). Patients with preserved postoperative sexual function after RARP showed better urinary function than those with impaired sexual function. Hence, preserved sexual function is closely associated with urinary function.

Complications after surgical correction of penile fractures-Is there a clinical impact?

Surgical exploration and closure of the tunica albuginea is the recommended treatment for penile fractures. The recovery of sexual function is the main result that surgeons and patients pursue. We sought to evaluate the sexual health effects of a surgically corrected penile fracture. Secondarily, we sought to identify risk factors that may influence long-term sexual function and their effects on genital body image satisfaction. A retrospective analysis of patients who underwent surgical correction of penile fractures between 2007 and 2022 in a tertiary center was performed. Lesion characteristics, weeks until the resumption of sexual activity, and post-operative sexual function were recorded. The presence of glans hypoesthesia, penile deformation, penile nodule palpation, and self-satisfaction with body image were assessed. Sixty-nine patients with a mean age of 42.30±12.98 years and a median follow-up of 70 (20-134) months were identified. Sexual intercourse was recorded as a percentage. Penile deformation was the most common complication, appearing in 14.5% of patients, erectile dysfunction in 5.8%, penile nodules in 4.3%, and glans hypoesthesia in 2.9%. The median post-operative International Index of Erectile Function-5 was 24 (21.5-24). Self-satisfaction with body image had a median of 9 and was negatively associated with bilateral lesions and penile deformation. Distal fractures could be linked to erectile dysfunction and glans hypoesthesia. Surgical correction of penile fractures shows positive functional and self-reported outcomes, and the potential andrological complications rarely necessitate specific treatment.

Better sex after hip arthroscopy; Sexual dysfunction in patients with femoro-acetabular impingement syndrome

BackgroundFemoro-acetabular impingement syndrome (FAIS) is a common cause of hip pain and functional decline. The quality of life of affected patients has been shown to be significantly diminished, with potential alterations in the ability to perform activities of daily living and recreation, including sexual function. Hip arthroscopy is the surgical technique recognized as the gold standard in FAIS. The aim of this study was to research the relationship between hip arthroscopy due to FAIS and pre- and postoperative sexual function. HypothesisThe hypothesis of the study was that sexual dysfunction would be common during the preoperative period but would significantly improve after surgery. Materials and methodsThis retrospective study included 96 patients aged 18 to 55 years, who underwent hip arthroscopy for a FAIS diagnosis between 2015 and 2021, with a minimum follow-up of one year. Exclusion criteria were a bilateral symptomatic hip condition, history of ipsilateral hip or knee surgery, history of urological or gynecological conditions, sexual dysfunction, or a history of hip osteonecrosis or osteoarthritis. The Female Sexual Function Scale (FSFI) was used to evaluate sexual dysfunction in females and the International Erectile Function Index (IIEF-5) for males. ResultsThe patients comprised 56.3% males and 43.82% females with a mean age of 35.3±8.3 years. Sexual dysfunction was determined preoperatively in 85.2% of the males and in 57.1% of the females. Overall improvement after surgery was statistically significant. Signs of pudendal nerve damage were seen during the postoperative period in 29 (30.2%) patients. The change in total sexual scores was significantly correlated with nerve symptoms and regression analysis showed that traction time was a significant risk factor for pudendal nerve symptoms. DiscussionSexual dysfunction is a common trait of patients suffering from FAIS and the majority of patients significantly benefit from the procedure. Sexual dysfunction persists in a category of patients during the postoperative period, regardless of the type of lesion, and this phenomenon is associated with transient pudendal nerve symptoms, which are more likely to occur with longer traction times and thus represent a clear risk factor. Level of evidenceIV.

Repeated transvaginal natural orifice transluminal endoscopic surgery: An initial Chinese experience.

To investigate the perioperative outcomes and sexual function of patients undergoing repeated transvaginal natural orifice transluminal endoscopic surgery (vNOTES). We retrieved the records of patients who underwent vNOTES twice at our institute between April 2019 and December 2022 and analyzed their baseline information and perioperative complications, and compared the pre- and postoperative sexual function of both vNOTES. Patients' mean age and body mass index were 29.00 ± 3.59 and 30.4 ± 4.00 years and 21.89 ± 3.69 and 22.76 ± 3.88 kg/m2 , respectively, when receiving the first and second vNOTES. Ectopic pregnancy was the most frequent indication for vNOTES, with 7 cases in the first vNOTES and 11 cases in repeated vNOTES. The interval between the two vNOTESs ranged from 9 days to 38 months. The operation duration (63.33 ± 13.71 vs. 67.33 ± 22.51 min, p = 0.723), intraoperative estimated blood loss (32.00 ± 20.42 vs. 30.00 ± 9.26 mL, p = 0.429), and duration of postoperative hospital stay (2.20 ± 0.56 vs. 2.40 ± 0.51 days, p = 0.082) of both vNOTESs were comparable. No significant differences were found in any of the domains in the comparison of pre-first and post-first vNOTES, pre-second and post-second vNOTES, and pre-first and post-second vNOTES female sexual function index. None of the patients delivered after the second vNOTES. Repeated vNOTES is safe and feasible. No significant change in the patients' sexual function was found in our cohort after the first and second vNOTES.

Retzius-Sparing Robot-Assisted Radical Prostatectomy in treatment of prostate cancer – presentation of the method and results

Background: Prostate cancer is a malignant cancer and the second most frequent malignancy in men. Millions of people are suffering from this problem across the globe. The gold standard for the treatment of this disease is considered radical prostatectomy. This method can lead to a complete cure but is not free of complications. Retzius-sparing modification of robot-assisted radical prostatectomy is a new method that can contribute to better results in faster recovery.&#x0D; Aim of this study: To present the difference between the Retzius-Sparing Robot-Assisted Radical Prostatectomy (RS-RARP) and the Standard Robot-assisted Radical Prostatectomy (S-RARP) in method and results.&#x0D; Materials and methods: A review was conducted in PubMed and Google Scholar including publications from the last 9 years. Literature was searched using the following terms: “Retzius-sparing”, “robot-assisted radical prostatectomy” and “prostate cancer”.&#x0D; Results and conclusion: Retzius-Sparing Robot-Assisted Radical Prostatectomy is a relatively new method that can improve results in prostate cancer treatment. In analyzed original articles RS-RARP compared to s-RARP showed better recovery of continence and lower risk of hernia. Although there were no significant differences in postoperative sexual function, positive surgical margins, and 1-year-biochemical recurrence rate.

(92) HYSTERECTOMY AND SEXUAL (DYS)FUNCTION: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Objectives We meta-analyzed change in sexual function from pre-hysterectomy to post-hysterectomy and the role of cervix removal and bilateral salpingo-oophorectomy (BSO) in differences in such change. Methods We searched PubMed, Embase, and Cochrane from inception-January 2022. Two reviewers screened and included studies if they were published in a peer-reviewed journal and reported on sexual function pre-hysterectomy and post-hysterectomy for benign, non-prolapse indication. Methodological quality was assessed using the STROBE-checklist. We used random-effects multilevel-models to meta-analyze standardized mean-differences in preoperative to postoperative sexual function and the post-hysterectomy FSFI-mean across study groups in R(-Studio). Results We analyzed 32 articles: eight randomized-controlled-trials, 20 prospective studies, two retrospective studies, one cross-sectional study, and one secondary analysis compromising 4054 patients. Study quality was moderate and effect-sizes showed large between-study heterogeneity. Hysterectomy was not associated with significant change in overall sexual function irrespective of surgical route with patients tending to report (potentially remaining) sexual dysfunction post-hysterectomy. Cervix removal was not significantly associated with differences in change. Hysterectomy without (-)BSO was associated with significantly stronger improvement in lubrication and orgasm than hysterectomy with (+)BSO which was not the case for desire and arousal nor overall sexual function. However, these significant differences were not replicated within studies that directly compared +/-BSO. Conclusions (Subtotal and total) hysterectomy was not associated with significant change in overall sexual function irrespective of surgical route with patients tending to report (potentially remaining) sexual dysfunction post-hysterectomy. Hysterectomy-BSO was associated with significantly stronger improvement in lubrication and orgasm than hysterectomy+BSO, but not for desire and arousal, nor overall sexual function. Conclusions need to be interpreted with caution due to the moderate methodological study quality and large heterogeneity. Future research should study predictors of different sexual function change-trajectories associated with hysterectomy, such as different indications. Clinicians should address (remaining) sexual dysfunction post-hysterectomy and BSO should not be considered if not medically required. Conflicts of Interest J.A.F. Huirne received various research grants (Samsung, NWO/TTW/ZonMw), participated in an international course sponsored by Samsung, and a congress on surgical treatment by Olympus for which she received compensation for travel expenses, all of which were not related to the studied subject. She is chair of the niche working group of the ESGE (European Society of Gynaecological Endoscopy) and chair of the research committee of the NVOG (Dutch Society for Obstetrics and Gynaecology). The other authors have nothing to disclose.

(131) Sexual Activity After Pelvic Surgery

Abstract Introduction Around 50%-70% of all women, at any moment of their lives, will undergo pelvic surgery such as abdominal and vaginal hysterectomies, laparoscopic or robotic-assisted hysterectomies, and exploratory laparotomies for multiple reasons. These reasons include; endometriosis, chronic pelvic pain, pelvic adhesions secondary to pelvic inflammatory disease, infected or perforated IUDs, previous surgeries, abscesses or cysts, peritonitis, and genital prolapses such as cystoceles, rectoceles, uterine prolapse or vaginal prolapse in patients with previous hysterectomies, urinary and fecal incontinence, and total procidentia. The general public knowledge, distorted sexual education curriculum, and the influence of this inappropriate sexual education (produced by religions and cultures) affect the medical practice and investigations at scientific levels. These influences have expanded the beliefs that sexual activity is deteriorated for all of these kinds of procedures. Few American publications and many Asian publications report the frank deterioration of the sexual response in women who have had pelvic surgeries. Objective To show how a very high percentage of women, that have had pelvic surgeries, have an improvement in their sexual activity after these kinds of procedures. Methods This investigation analyzed the postoperative sexual function of hundreds of patients at our two centers in which all the procedures previously named were practiced. Results We found an improvement in sexual activity, not only in the women but also in the couples in more than 95% of the cases. The pre and post-procedure evaluations were done. Conclusions Contradictory to what several studies have shown regarding how pelvic surgeries produced deterioration in sexual activity, we have demonstrated the opposite. We found that in more than 95% of the cases, sexual activity was improved. These procedures included repairing total procidentia, cystocele, rectocele, urinary incontinence or rectal incontinence, fibroid uterus, or chronic pelvic pain. Disclosure No

Cystoscopic removal of transvaginal mesh: Long-term outcomes.

This study's aim is to evaluate the long-term quality of life and functional outcomes following cystoscopic excision of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) mesh extruded into the urinary tract in women. A retrospective chart review was performed of all cases of cystoscopic removal of extruded mesh at our high-volume tertiary care centre between April 2013 and August 2021. Postoperative patient-reported outcomes were collected via questionnaires: Urogenital Distress Inventory Short Form (UDI-6), EQ-5D-5L Visual analogue scale, ICIQ-Satisfaction (ICIQ-S) and additional questions regarding postoperative sexual function. During the study period, 27 women with a median age of 61 years (45-87) underwent cystoscopic mesh removal surgery using either Ho-YAG laser (56%) or bipolar loop resection (44%). The most common presentation of mesh extrusion was recurrent urinary tract infections (67%). Other presenting complaints were pain (41%), urinary urgency ± incontinence (41%) and voiding difficulties (18%). Long-term follow-up outcomes from 20 patients (median follow-up: 24 months) showed that mesh removal was rated successful by 80%, and 100% would choose to have the surgery again if in the same situation. Recurrent SUI was reported by 45% of respondents, and urinary urge incontinence was found in 50%. For patients who answered the sexual function questions, 50% reported improved sexual function postmesh removal (6/12). Cystoscopic removal of extruded female SUI and POP mesh is associated with high patient satisfaction and low morbidity in appropriately selected patients at 2-year median follow-up. A patient-centred shared decision-making process is essential in counselling patients regarding options and expected outcomes following mesh removal surgery.

(144) Clitoral Anatomy and its Relation to Sexual Function after Apical Prolapse Repair using Pelvic MRI

Abstract Introduction The clitoris is the primary sexual organ involved in the physiological changes that occur during the female sexual response. Sparse research and contradictory evidence concerning clitoral anatomy and its role in female sexual function exist, especially in the context of pelvic floor disorders and their surgical correction. Comprehensive description of clitoral anatomy and how it relates to postoperative sexual function in women surgically treated for pelvic floor disorders is necessary to better understand the pathophysiological mechanisms of female sexual dysfunction following gynecologic surgery. Objective To identify characteristics of clitoral anatomy (size, location, shape) associated with female sexual function in women after vaginal hysterectomy with uterosacral ligament suspension (native tissue repair, NTR) or transvaginal mesh (VM) hysteropexy for uterovaginal prolapse. We hypothesized that a smaller clitoris and clitoral components would correlate with poorer sexual function. Methods In this ancillary study of women enrolled in a randomized clinical trial, 30–42-month postoperative axial MRIs of 82 women surgically treated (41 NTR, 41 VM) were obtained at rest. The clitoral components (glans, body, crura) and vestibular bulbs were segmented to create 3D models of the “clitoral complex” (Figure 1). Using these models and computational morphometry, clitoral dimensions and position were computed with respect to a 3D pelvic coordinate system (Figure 2). After aligning, normalizing (scaling), and establishing corresponding points between models, statistical shape modeling was performed via Principal Component Analysis (PCA) to identify/quantify significant modes of anatomic variation of the clitoris. Participant data included demographics, medical history, sexual activity status, and Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR). The relationships between clitoral measurements/shape and sexual function were evaluated using Spearman rank correlation. Results For this group of mostly postmenopausal women (80/82 [97.6%]), median (min-max) age was 65.3 (47-79), 15/82 (18.3%) were sexually active (SA), and 21/82 (25.6%) were not sexually active (NSA) postoperatively (46/82 [56.1%] did not respond). Among SA women, a smaller glans width correlated with overall poorer sexual function (lower PISQ-IR mean score) (r=0.74, p=0.002), frequent feelings of shame/fear with leakage of urine/stool during sex (r=0.69, p=0.004), and low sexual arousal (r=0.61, p=0.02). A smaller glans height correlated with dyspareunia (r=-0.64, p=0.02) and less intense orgasms postoperatively (r=0.64, p=0.01). A smaller glans volume correlated with low sexual arousal (r=0.60, p=0.02) and a clitoral complex farther away from participants’ midline (midsagittal plane) correlated with greater negative impact of incontinence/prolapse on sex life (r=-0.66, p=0.007). Among NSA women, a clitoris farther away from participants’ midline was associated with dyspareunia as a strong reason for sexual inactivity (r=0.49, p=0.03). From the PCA, 11 significant modes of shape variation were found. For SA women, Modes 5 and 8 correlated with leakage of urine/stool during sex (r=-0.65, p=0.009) and dyspareunia (r=-0.59, p=0.04), respectively (Figure 3). For NSA women, Mode 4 correlated with dyspareunia as a strong reason for sexual inactivity (r=0.46, p=0.04) (Figure 3). Conclusions Poorer sexual function was associated with a smaller clitoral glans (width, height, volume) among SA women and a clitoral complex positioned farther away from participants’ midline in SA and NSA women following prolapse surgery. Disclosure Yes, this is sponsored by industry/sponsor: Boston Scientific Clarification Industry funding only - investigator initiated and executed study