Preoperative Sexual Function Research Articles

MP59-11 ORGASMIC FUNCTION WORSENING COULD LEAD TO ERECTILE FUNCTION DECREASE AFTER HoLEP RESULTS FROM A PROSPECTIVE TRIAL (Expho)

You have accessJournal of UrologyCME1 Apr 2023MP59-11 ORGASMIC FUNCTION WORSENING COULD LEAD TO ERECTILE FUNCTION DECREASE AFTER HoLEP RESULTS FROM A PROSPECTIVE TRIAL (Expho) Paolo Capogrosso, Andrea Salonia, Giuseppe Fallara, Edoardo Pozzi, Eugenio Ventimiglia, Schifano Nicolò, Federico Belladelli, Alessandro Bertini, Luca Boeri, Francesco Lanzaro, Luigi Candela, Federico Dehò, and Francesco Montorsi Paolo CapogrossoPaolo Capogrosso More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , Giuseppe FallaraGiuseppe Fallara More articles by this author , Edoardo PozziEdoardo Pozzi More articles by this author , Eugenio VentimigliaEugenio Ventimiglia More articles by this author , Schifano NicolòSchifano Nicolò More articles by this author , Federico BelladelliFederico Belladelli More articles by this author , Alessandro BertiniAlessandro Bertini More articles by this author , Luca BoeriLuca Boeri More articles by this author , Francesco LanzaroFrancesco Lanzaro More articles by this author , Luigi CandelaLuigi Candela More articles by this author , Federico DehòFederico Dehò More articles by this author , and Francesco MontorsiFrancesco Montorsi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003312.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Holmium laser enucleation enucleation of the prostate (HoLEP) has been associated with a low risk of erectile dysfunction (ED). We investigated factors associated with risk of erectile function (EF) worsening after surgery for men with normal pre-operative EF. METHODS: The ExpHo trial (NCT03583034) is a prospective study collecting data of consecutive patients treated with HoLEP by one highly-experienced surgeon (>1500 cases), at a single centre. All patients completed the International Index of Erectile Function (IIEF) at baseline and those with normal IIEF-EF (>26) were considered for this analysis. Patients have been re-assessed at 1 week, and at 1, 3, 6 and 12 months throughout the follow-up (FU). Kaplan Meier analysis investigated the risk of EF decrease over time. Cox-regression model tested predictors of post-operative EF worsening. RESULTS: Of 242 patients, 66 reported normal IIEF-EF before surgery. Baseline median (IQR) age was 65(60-70) years and prostate volume (PV) was 75(58-100) mL. Median pre-operative IIEF-orgasmic function (OF) was 10(7-10). Median follow-up was 6(1-12) months. At Kaplan-Meier analysis, estimated rates of EF impairment depicted an increase over time, with 12%(95%CI: 6,25) and 19%(95%CI: 11,33) of patients with normal pre-operative EF reporting a post-operative worsening at 3 and 6 months, respectively. Median IIEF-EF score decrease was 4 (2-11). At cox regression analysis, baseline factors (i.e., age, BMI, Charlson Comorbidiy Index, PV, IPSS) and intraoperative factors (i.e., total energy used, capsule perforation) were not associated with EF decrease over time (all p>0.6). Conversely, patients experiencing a post-operative decrease of IIEF-OF were at higher risk of reporting IIEF-EF worsening (IIEF-OF: HR 0.81; 95%CI: 0.59, 0.94; p=0.009) (Figure 1). CONCLUSIONS: Sexually active patients with normal pre-operative sexual function may experience a non-negligible EF worsening after HoLEP, which appears associated with post-operative OF decrease, thus suggesting that the impairment of antegrade ejaculation could play a major influence in post-HoLEP sexual function. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e811 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Paolo Capogrosso More articles by this author Andrea Salonia More articles by this author Giuseppe Fallara More articles by this author Edoardo Pozzi More articles by this author Eugenio Ventimiglia More articles by this author Schifano Nicolò More articles by this author Federico Belladelli More articles by this author Alessandro Bertini More articles by this author Luca Boeri More articles by this author Francesco Lanzaro More articles by this author Luigi Candela More articles by this author Federico Dehò More articles by this author Francesco Montorsi More articles by this author Expand All Advertisement PDF downloadLoading ...

Prospective randomized study to evaluate and compare the post-procedural sexual function in patients undergoing semi-rigid ureterorenoscopy for distal ureteric stones in three different operating room settings

ObjectiveTo evaluate and compare the effect of semi-rigid ureterorenoscopy on post-procedural sexual function with three different operating room settings. MethodsIn this prospective randomized study, consecutive sexually active patients with normal pre-operative sexual function undergoing uncomplicated semi-rigid ureterorenoscopy for distal ureteric stones were randomized into three groups, with three different operating room settings. Procedure-related anxiety and sexual function were assessed pre-operatively using Amsterdam Preoperative Anxiety and Information Scale and Brief Sexual Function Inventory (in males) and Female Sexual Function Index-6 (in females), respectively. All the participants were stented following the procedure, and the stent was removed after 3 weeks. Post-procedural sexual function and general discomfort were assessed and compared between three groups at 1 week, 3 weeks, and 12 weeks. The effect of surgery-related anxiety, preoperative sexual function, age, and general discomfort (including stent-related discomfort) on post-procedural sexual function were analyzed using multiple regression analysis. A p-value of less than 0.05 was considered statistically significant. ResultsTotally, 327 eligible patients were randomized into three groups. The group of patients who underwent the procedural with a screen separating the operating area from the patient vision, while the patient could watch the endoscopy through a separate monitor, had better post-procedural sexual function compared to those who had total vision of the operating area as well as to those whose eyes were blocked. This difference was statistically significant. This post-procedural reduction in sexual function could not be attributed to in situ stent alone. ConclusionsOur study showed that semi-rigid ureterorenoscopy can have significant negative effect on sexual function, which can be reduced with proper preoperative counseling and an ideal operating room settings.

PD19-10 PATIENT AND DISEASE SPECIFIC RISK FACTORS AND NERVE SPARING HAVE A SIGNIFICANT IMPACT ON LONG TERM SEXUAL FUNCTIONAL FOLLOWING MINIMALLY INVASIVE RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy II (PD19)1 Sep 2021PD19-10 PATIENT AND DISEASE SPECIFIC RISK FACTORS AND NERVE SPARING HAVE A SIGNIFICANT IMPACT ON LONG TERM SEXUAL FUNCTIONAL FOLLOWING MINIMALLY INVASIVE RADICAL PROSTATECTOMY Nicholas Raison, Gledisa Musollari, Kathy Man, Natasha Bhate, Joanne Sethi, Alexandra Forde, Hashim Ahmed, Suks Minhas, and Mathias Winkler Nicholas RaisonNicholas Raison More articles by this author , Gledisa MusollariGledisa Musollari More articles by this author , Kathy ManKathy Man More articles by this author , Natasha BhateNatasha Bhate More articles by this author , Joanne SethiJoanne Sethi More articles by this author , Alexandra FordeAlexandra Forde More articles by this author , Hashim AhmedHashim Ahmed More articles by this author , Suks MinhasSuks Minhas More articles by this author , and Mathias WinklerMathias Winkler More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002008.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Erectile dysfunction remains a major source of morbidity for patients following radical prostatectomy (RP). This study aims to identify patient related as well as peri- and post-operative factors that may affect long-term sexual function following RP. METHODS: A prospectively maintained database of patients who had undergone minimally invasive RP was analysed. Patient reported outcomes measures were assessed in all patients using the validated RAND 36-Item Survey and UCLA prostate cancer index questionnaires completed at regular intervals PROMS evaluated functional (urinary, bowel and sexual scored out of 100) and general health outcomes following RP. Further data including clinical and pathological details for all patients was collected. Univariable logistic regression analysis was used to identify potential factors. Analysed factors were age, comorbidities, BMI, previous LUTS surgery, neoadjuvant or adjuvant radiotherapy or ADT, nerve sparing (NS), prostate size and complications. Potential factors were analysed graphically. Patients with pre (n=6) and post (n=163) RP radiotherapy were included. RESULTS: 494 of 700 patients had PROMS and were analysed with a mean follow up of 31 months (range 1-150 months). Mean preoperative sexual function score 54 (range 0-100) with sexual function score continuing to improve until 24 months. There was no long-term deterioration in either overall mental or physical health. NS had a significant effect on long term sexual function (p < 0.001) with progressive benefits following bilateral intrafascial and unilateral intrafascial/ extrafascial NS compared to no NS (Figure 1). Age and prostate size were the only patient related factors to impact post-operative sexual function (p=0.003 and p=0.03 respectively). Sexual function was also affected with the D’Amico risk group (p=0.001) and use of postoperative ADT (p=0.02). Adjuvant or neoadjuvant radiotherapy had no effect. CONCLUSIONS: Patient and disease specific factors and nerve sparing can have a significant effects on post operative sexual function. Discussion with the patient on individual risks should undertaken when making treatment decisions. Source of Funding: No funding © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e365-e366 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nicholas Raison More articles by this author Gledisa Musollari More articles by this author Kathy Man More articles by this author Natasha Bhate More articles by this author Joanne Sethi More articles by this author Alexandra Forde More articles by this author Hashim Ahmed More articles by this author Suks Minhas More articles by this author Mathias Winkler More articles by this author Expand All Advertisement Loading ...

Women's Experience of Their First Sexual Encounter After Pelvic Reconstructive Surgery.

To describe the timing, quality and patient concerns regarding the first sexual encounter after surgery for pelvic organ prolapse (POP) or urinary incontinence (UI). Women scheduled to undergo POP or UI surgery who self-identified as sexually active were recruited to this qualitative study. Routine counseling regarding the return to sexual activity was provided 4-6 weeks postoperatively. Participants completed interviews 2-4 months after their surgery. Interviews were tape recorded, de-identified, and transcribed. Transcriptions were coded for major themes by two independent researchers; disagreements were arbitrated by the research team. Analysis was performed using Dedoose software. Twenty patients with an average age of 52.4 years participated. Most identified themselves as White (85%), one quarter had a history of hysterectomy, and 15% had previously undergone pelvic reconstructive surgery. Nineteen (95%) patients resumed intercourse 2-4 months after surgery. Thematic saturation was reached with major themes of Outside Influences, Conflicting Emotions, Uncertainty, Sexual Changes and Stability, Normalization, and Self-Image. First sexual encounter timing was strongly influenced by partners' desires and fears and physician counseling. Fear of damage to repairs affected patients' comfort with return to sexual activity. Although uncertain of how anatomical changes or presence of mesh would affect function, women hoped that changes would be positive, regardless of preoperative sexual function. Some women found their experience unchanged, whereas others reported need for change in sexual position, use of lubrication, and sensation of foreign body. Positive changes included increase in desire, pleasure, and improvement in orgasm. Self-image generally improved after surgery, which increased women's sexual confidence. The return to sexual activity after surgery for POP or UI represents a great unknown for many women. Reports of initial sexual activity after surgery are often positive, and physicians strongly influence initial postoperative sexual encounter timing. Frank counseling about patient and partners' fears regarding the effect of repair on sexual activity would likely improve patients' outcomes.

This Month in Adult Urology

This Month in Adult Urology

What Women Want: Radical Cystectomy and Perioperative Sexual Function Educational Needs

ObjectiveTo assess the extent and adequacy of pre-operative sexual function (SF) counseling in females undergoing radical cystectomy (RC) and develop educational material to improve identified deficits. MethodsA 10-question survey was electronically delivered to all females who underwent RC at a single institution between 2015 and 2020. 23 of 145 patients responded (15.9%). In addition, women on the Bladder Cancer Advocacy Network (BCAN) patient discussion board were also queried. The primary outcome was the development of a patient educational handout based on patient perception of pre-operative SF counseling and self-reported changes in post-operative SF. Results22 women, 84% of whom were sexually active, met the inclusion criteria. More than half (12/22, 54.5%) reported receiving no pre-operative counseling regarding possible SF changes while another 27.3% (6/22) received some counseling but desired more. Most women rated vaginal preservation as moderate to very important (17/22, 77.3%) and nearly all women noted at least one change in SF, most commonly dyspareunia (13/22, 59.1%). Most also desired more information regarding female sexual health. Separately, the BCAN discussion board was queried regarding patient preference for modality of pre-operative counseling. 77.8% (14/18) preferred a discussion with provider and 13/18 (72.2%) also wanted a written handout. ConclusionsSexual dysfunction is prevalent following RC in women and many desire more pre-operative counseling, regardless of disease stage or receipt of chemotherapy. These findings supported our development of interventions to improve pre-operative education as well as strategies to address post-operative SF changes, such as dyspareunia.

A Predictive Preoperative and Postoperative Nomogram for Postoperative Potency Recovery after Robot-Assisted Radical Prostatectomy.

Prediction of potency recovery following robot-assisted radical prostatectomy (RARP) is useful for better patient counseling and postoperative treatment strategies. In this study we propose a preoperative and postoperative nomogram to predict postoperative potency recovery following RARP. Patients from development set (6,502) were selected to develop the nomograms, and patients in validation set (2,706) were used for validation. Cox regression models were fitted on the development cohort to predict potency recovery after RARP using as prognostic factors the covariates selected. Two nomograms were drawn using the regression coefficients of the preoperative and postoperative Cox models. The discrimination ability of the preoperative model was evaluated on the development cohort using the receiver operator curves estimated at 3, 6, 12 and 24 months. The AUC at these time points was 0.726, 0.734, 0.754, and 0.778, respectively. The areas under the curve of the postoperative model at 3, 6, 12 and 24 months were 0.746, 0.756 and 0.777, and 0.801, respectively. Preoperative and postoperative predictive models were validated using a separate set of 2,706 patients. The AUCs of the preoperative model at 3, 6, 12 and 24 months were 0.789, 0.772, 0.768, and 0.778, respectively. The ROC curves of the postoperative model at 3, 6, 12 and 24 months with AUCs of 0.807, 0.797, 0.793 and 0.798, respectively. Along with age and preoperative sexual function, nerve-sparing technique determines the potency outcomes justifying better AUC for postoperative model vs the preoperative model. The above nomograms help us to predict with good accuracy the probability of potency recovery within 3, 6, 12 and 24 months following surgery taking into consideration preoperative and postoperative factors. This is a novel tool for the care giver to predict realistic expectation of potency outcomes to the patients, while preoperative and immediate postoperative counseling.

Width of spared neurovascular bundle after robot-assisted laparoscopic prostatectomy in patients with prostate cancer: is it a reliable factor for predicting postoperative sexual outcome?

PurposeTo investigate the relationship between the width of spared neurovascular bundle (NVB) measured during robot-assisted laparoscopic prostatectomy and postoperative sexual outcomes.MethodsPatients with localized prostate cancer with erectile hardness score ≥2 (N = 105) who underwent NVB-sparing robot-assisted laparoscopic prostatectomy were included. Patients were divided into three groups [first (Q1) vs. second and third (Q2-3) vs. fourth (Q4) quartile] according to width of spared NVB measured with a flexible ruler after prostate removal. Preoperative and postoperative sexual function was evaluated according to erectile hardness score and Expanded Prostate Cancer Index Composite questionnaires.ResultsThe proportion of patients with postoperative erectile hardness score ≥2 at postoperative 6 months was as follows: 38.9% (Q1), 48.6% (Q2–3), and 83.3% (Q4) (P = 0.016). The preoperative/postoperative 6-month sexual function score was 40.7/16.9 (Q1), 48.1/19.0 (Q2–3), and 51.2/28.1 (Q4). Postoperative sexual function was significantly associated with preoperative sexual function in Q4 (P = 0.006) and Q2–3 (P = 0.030) but not in Q1. On multivariate analysis, the width of spared NVB was a significant predictor for postoperative 6-month erectile hardness score ≥2. Limitation includes selection bias and short follow-up duration.ConclusionsNot only the performance but also the degree and quality of NVB sparing thought to be important for postoperative sexual function. Measurement of the width of NVB during surgery could be an easy intraoperative method for assessing the quality of NVB sparing.

14 - Free testosterone predicts preoperative sexual function in men over 60 years of age with prostate cancer

14 - Free testosterone predicts preoperative sexual function in men over 60 years of age with prostate cancer

Intraoperative application of platelet-rich plasma to the neurovascular bundles during radical prostatectomy: A prospective clinical trial.

TPS380 Background: Radical prostatectomy (RP) is the most common surgical treatment for prostate cancer (PC). Yet even with nerve-sparing RP (NS-RP), a significant proportion of men experience transient or permanent erectile dysfunction (ED) partially due to intraoperative neurovascular bundle (NVB) damage from thermal or mechanical trauma. Studies have shown that platelet released growth factors counteract trauma and facilitate healing. We evaluate the use of platelet rich plasma (PRP) to facilitate early nerve healing and decrease ED after NS-RP. Methods: A prospective, open label, 20 subject human trial evaluating intraoperative topical NVB PRP application was approved by the IRB and FDA under an Investigational Device Exemption (IDE 16915) for the investigational use of an approved blood separation device. Men aged 50-60 with newly diagnosed, localized PC and normal preoperative sexual and urinary function, defined as a Sexual Health Inventory for Men (SHIM) score of &gt;19 and an answer of “none” on question 5 of the Expanded Prostate Cancer Index Composite (EPIC) are eligible. Intraoperatively, a 10ml PRP product is created from a 180 mL sample of the patient’s whole blood using the Angel Concentrated Platelet Rich Plasma System (Cytomedix, Inc., Gaithersburg, MD USA). PRP is applied via mechanical transfer to the NVB after completion of the vesicourethral anastomosis. The primary endpoint is the safety and tolerability of PRP on the NVB after NS-RP. Secondary endpoints include feasibility of intraoperative PRP application and longitudinal assessment of erectile function and urinary continence by questionnaire administration at 3, 6, 9, 12 and 18 months after NS-RP. Clinical trial information: NCT02957149.

Healthcare utilization in men with poorer sexual and urinary function recovery following robot-assisted radical prostatectomy.

Robotic radical prostatectomy focuses on oncologic cure, urinary continence and sexual function recovery. However, little is known about the effect of declines in urinary continence and sexual function on healthcare utilization. We aim to identify these factors. From March 2011 to September 2013, all men undergoing robotic prostatectomy within our healthcare system were enrolled. Men completed the expanded prostate cancer index composite-26 survey at the time of diagnosis and 90days post-operatively. Patients were stratified according to change in scores in the sexual function and urinary incontinence domains. Patient, treatment and post-op utilization patterns were examined for association with the extent of decline in sexual function and urinary continence. Multivariate linear regression was used to identify factors independently associated with decline in continence and sexual function. A total of 411 men who completed the baseline survey and at 90days postoperatively were included. On multivariate linear regression, younger age (p<0.01), higher preoperative sexual function (<0.01), single marital status (p=0.04) and more post-surgery email contacts (p=0.04) were associated with higher declines in sexual function. For continence, no family history of prostate cancer (p=0.01), higher baseline continence (p<0.01) and more post-surgery physical therapy visits (p<0.01) were associated with higher declines. Patients with the poorest quality of life outcomes at 90days post-operatively were more likely to seek care via email and physical therapy encounters related to sexual function and urinary incontinence, respectively. This suggests that maximizing post-treatment quality of life can potentially reduce healthcare utilization.

Laparoscopy combined with transperineal extralevator abdominoperineal excision for locally advanced low rectal cancer

To evaluate the laparoscopy combined with transperineal extralevator abdominoperineal excision (TP-ELAPE) for locally advanced low rectal caner. Clinical data of 12 patients with locally advanced low rectal cancer undergoing laparoscopy combined with TP-ELAPE in our department from May 2013 to March 2015 were retrospectively analyzed. There were 8 male and 4 female patients with median aged of 63 (46 to 72) years. The median distance from tumor lower margin to anal verge was 3.5(2.0 to 4.0) cm. A self-made transanal suit for minimally invasive operation was used to make a sealed lacuna outside the sphincter, thus laparoscope can be applied to perform transperineal operation. All the patients underwent operations successfully without conversion to open abdominal operation. The median operating time was 206 (180 to 280) minutes with perineal operating time 95(80 to 120) minutes. The median intraoperative blood loss was 120(50 to 200) ml. The median postoperative hospital stay was 12(9 to 18 ) days. Postoperative pathology revealed that all circumferential margins (CRM) were negative. The area of sample horizontal section was (2 824±463) mm(2), and of outer muscularis propria was(2 190±476) mm(2). Postoperative complications included chronic sacrococcygeal region pain in 2 cases, urinary retention in 3 cases, perineal wound infection in 1 case. No perineal seroma, perineal hernia, wound dehiscence and sinus tract formation were observed. Among 8 patients with preoperative normal sexual function, sexual dysfunction occurred in 2 patients. There was no local recurrence and metastasis during a median follow-up of 21(12 to 34) months. Laparoscopy combined with TP-ELAPE has the potential to simplify the operation procedure for low rectal cancer, can ensure the radical treatment and safety of operation, and may be carried out in experienced centers.

Surgical Management for Pelvic Organ Prolapse and Its Impact on Sexual Function.

Female sexual function is complex, incorporating physical, emotional, and psychological factors. Pelvic organ prolapse, descent of the pelvic organs to or through the vaginal opening, is a common condition that affects quality of life, including sexual function. Symptomatic prolapse is most commonly treated with reconstructive surgery. To address the surgical management of pelvic organ prolapse and its impact on sexual function and include recommendations for evaluating sexual function, use of validated questionnaires to assess function, preoperative counseling, and postoperative follow-up. A literature search was performed for articles evaluating sexual function after pelvic organ prolapse surgery. Priority was given to larger studies, including systematic reviews, and use of validated questionnaires. The main outcome was postoperative sexual function after pelvic organ prolapse repair. Multiple surgical approaches are used for the treatment of pelvic organ prolapse, including native tissue and grafted repairs. An evaluation of sexual function preoperatively is necessary to decide on type of surgery and to establish appropriate postoperative expectations. Postoperatively, most patients report sexual function as improved or unchanged. Thorough preoperative counseling allows patients and their physicians to develop appropriate, individualized treatment plans for pelvic organ prolapse that consider women's preoperative sexual function and sexual function goals.

Effects of the lower extremity external fixators on the sexual life of males.

In tibial fractures, the use of an external fixator (EF) may be associated with sexual dysfunction (SD) in sexually active male patients. We aimed to investigate the influence of EF applied for tibial fracture on the sexual life in male patients. We retrospectively evaluated 137 male patients who presented with tibial fractures and underwent surgical intervention with unilateral or circular EF. The patients completed the Brief Sexual Function Inventory (BSFI) form during the interview. We evaluated the incidence of the development of SD and the severity of SD with the use of an EF, and the relation with the type of EF and SD was investigated. The responses were compared with the results of the completed BSFI forms of 119 male patients who were treated with internal fixation (IF) for tibial fractures. In total, 108 patients (mean age, 42.8 years) treated with EF accepted the invitation and filled the form. The score of those patients were worse compared with that of the patients who were treated with IF (p<0.001). Postoperative sexual functions were the same with the preoperative sexual function in 12 patients (11%). However, the postoperative scores were decreased in 96 (89%) patients, which meant that the sexual functioning was impaired. None of the patients reported persistent SD. EF in the cruris may impair sexual functions in males. The rate of SD was higher in male patients who were treated with EF. Thus, SD might be associated with physical, psychological, and social limitations caused by EF.

Use of a Hyaluronic Acid-Carboxymethylcellulose Adhesion Barrier on the Neurovascular Bundle and Prostatic Bed to Facilitate Earlier Recovery of Erectile Function After Robot-Assisted Prostatectomy: An Initial Experience

To investigate the efficacy of hyaluronic acid-carboxymethylcellulose (HACM) in facilitating early recovery of erectile function (EF) after radical prostatectomy, we report our initial experience of HACM use on the neurovascular bundle (NVB) after robot-assisted radical prostatectomy (RARP). Between 2008 and 2010, 459 consecutive patients who underwent RARP with bilateral nerve-sparing technique were included in this study. Patients were classified into two groups: HACM (group 1; n=162) and non-HACM (group 2; n=287). HACM was delivered to the anatomic location of the NVB after prostate removal. We retrospectively analyzed the surgical outcomes including EF, continence, and perioperative complications. At 6 months after surgery, EF recovery rate was 28.5% in group 1 and 17.4% in group 2 (P=0.006). In a subgroup analysis consisting of 225 patients with a preoperative International Index of Erectile Function Short Survey (IIEF)-5 score ≥20, the difference in EF recovery at 6 months was significant with 62.8% in group 1 and 27.0% in group 2 (P=0.002), respectively. HACM use was an independent predictor for EF recovery at 6 months after surgery (odds ratio, 2.735; 95% confidence interval, 1.613-4.638; P<0.001). Age and preoperative IIEF-5 were also independent predictors. No differences in continence at 6 months or perioperative complications were found between the two groups. EF recovery was not different between the two groups after 18 months. HACM use around the NVBs is safe and facilitates early recovery of EF after nerve-sparing RARP. HACM use is more effective in patients with normal preoperative sexual function.

Preoperative sexual function in women with rectal cancer

Even though sexual dysfunction has been reported after rectal cancer treatment, information on preoperative sexual function is scarce, particularly in female patients. To describe preoperative sexual function in women with rectal cancer, and to analyse potential sources of bias. The Female Sexual Function Index (FSFI) was administered to women with newly diagnosed non-metastatic rectal cancer, irrespective of whether they were sexually active or not. FSFI total and domain scores were calculated for women with complete responses to the corresponding items. Data were compared for those who did and did not complete all the FSFI domains, and for women in the study cohort, and those who were eligible for inclusion but not included. Sexual inactivity was common. Mean FSFI total score was low (16.4 ± 10.6 SD) among the women who completed all six FSFI domains. The proportion of women who had a partner was higher in this group compared with those who did not complete all the domains (49 of 57 vs 7 of 25, p < 0.001). Eighty-two of the 157 women eligible for inclusion were included. Included women were younger (p = 0.002) and had less co-morbidity than those who were not included (p = 0.025). The low FSFI total score indicates sexual dysfunction. However, the use of FSFI in both women who are and who are not sexually active complicates interpretation of the data and may result in an information bias hampering internal validity. External validity may be limited by selection bias.

Impact of rectopexy on sexual function: a cohort analysis

Laparoscopic ventral rectopexy (LVR) is an established surgical technique for the treatment of both rectal prolapse and symptomatic rectoceles. It is, however, not known whether LVR influences sexual function (SF). The aim of this study was, therefore, to determine the impact of this procedure on the SF of patients. All female patients after LVR procedure in a single institution were identified and were sent a questionnaire concerning SF. This addressed sexual activity, satisfaction, preoperative SF, and the impact of surgery on SF. Furthermore, the PISQ-12 validated sexual functioning questionnaire was sent to all female patients. A total of 217 patients were sent a questionnaire. These patients underwent LVR for rectal prolapse, symptomatic rectocele, or enterocele between 2004 and 2011. Mean age was 62 years (range 22-89). Mean follow-up was 30 months (range 5-83). Response rate was 64 % (139 patients). The number of sexual active patients dropped from 71 to 54 % after surgery. The number of patients being satisfied with their SF remained relatively equal; 91 % of patients before and 85 % of patients after surgery. Forty-three percent of patients stated that the LVR procedure did not influence their sexual function, in 16 % of patients, the procedure positively influenced their SF, and in 13 % of respondents, SF decreased after surgery. The mean PISQ-12 score postoperatively was 34 out of 48. The impact of LVR on SF of patients seems limited in this cross-sectional study in a large cohort of patients.

1008 MEN WITH LOW PREOPERATIVE SEXUAL FUNCTION MAY BENEFIT FROM NERVE-SPARING RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Localized (IV)1 Apr 20131008 MEN WITH LOW PREOPERATIVE SEXUAL FUNCTION MAY BENEFIT FROM NERVE-SPARING RADICAL PROSTATECTOMY Catherine Harris, Sanoj Punnen, and Peter Carroll Catherine HarrisCatherine Harris San Francisco, CA More articles by this author , Sanoj PunnenSanoj Punnen San Francisco, CA More articles by this author , and Peter CarrollPeter Carroll San Francisco, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.592AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The benefits of nerve-sparing radical prostatectomy (RP) for post-operative sexual function are well known, however, it is unclear whether nerve-sparing has a clear benefit in men with poor pretreatment sexual function. The objective of this study was to assess the effect of nerve-sparing radical prostatectomy on urinary and sexual function in men at various levels of pretreatment sexual function with a specific focus on men with poor function prior to surgery. METHODS Men within the CaPSURE database who underwent RP and had baseline and 2 year post-treatment UCLA Prostate Cancer Index (PCI) sexual and urinary function scores were selected for the study cohort. The degree of nerve-sparing was categorized as either complete bilateral, unilateral/partial, or no nerve-sparing, and the level of pre-treatment sexual function was divided into quartiles. The cohort was divided into subgroups of nerve-sparing technique and pre-treatment sexual function. Adjusted means of sexual function (SF) and urinary function (UF) within subgroups were calculated and the differences between means were tested using analysis of covariance. A test of interaction was performed between preoperative SF and degree of nerve-sparing on postoperative SF and UF scores. RESULTS 1,322 patients met the inclusion criteria. Median patient age was 61 (range 41-79). Bilateral, unilateral, and no nerve-sparing were performed in 899, 200 and 223 men, respectively. The effects of nerve-sparing on SF differed between the quartiles of pre-RP SF (p-value <0.01). Nerve-sparing did not have an effect on SF among men in the lowest quartile of pre-RP SF score (p=0.15), but had a significant benefit on SF in the higher three quartiles (p=0.04, p<0.01, p<0.01, respectively). Alternatively, nerve-sparing improved UF in men in the lowest quartile of baseline SF. CONCLUSIONS Nerve-sparing RP improves SF in most men with the exception of those with little/no baseline function. However, UF was positively impacted by nerve-sparing in these men. Men who are suitable candidates for nerve preservation based on the risk of extra capsular extension may benefit from nerve-sparing surgery. Poorer baseline sexual function should not exclude them from such surgery. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e414 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Catherine Harris San Francisco, CA More articles by this author Sanoj Punnen San Francisco, CA More articles by this author Peter Carroll San Francisco, CA More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Men with Low Preoperative Sexual Function May Benefit from Nerve Sparing Radical Prostatectomy

We determined the effect of nerve sparing radical prostatectomy on sexual and urinary function in men at various levels of pretreatment sexual function. Men in the CaPSURE™ (Cancer of the Prostate Strategic Urologic Research Endeavor) database who underwent radical prostatectomy and had baseline and 2-year posttreatment UCLA-PCI sexual function and urinary function scores were selected. Nerve sparing was categorized as bilateral, unilateral or none and the level of pretreatment sexual function was divided into quartiles. The cohort was divided into subgroups of nerve sparing technique and pretreatment sexual function. Differences between sexual function and urinary function among subgroups were determined. A test of interaction was performed between preoperative sexual function and degree of nerve sparing on postoperative sexual function and urinary function scores. A total of 1,322 patients met the study inclusion criteria. Median patient age was 61 years (range 41 to 79). Bilateral, unilateral and no nerve sparing procedures were performed in 899, 200 and 223 men, respectively. The effects of nerve sparing on sexual function differed among the quartiles of preoperative sexual function (p <0.01). Nerve sparing did not have an effect on the sexual function of men in the lowest quartile of preoperative sexual function score (p = 0.15) but did have a significant beneficial effect on sexual function in the higher 3 quartiles (p = 0.04, p <0.01 and p <0.01, respectively). Alternatively, nerve sparing improved urinary function in men in the lowest quartile of baseline sexual function. Nerve sparing radical prostatectomy results in better sexual function outcomes than no nerve sparing in most men except those with little baseline function. Urinary function was positively impacted in all men. Men who are suitable candidates for nerve preservation may benefit from nerve sparing surgery. Poorer baseline sexual function should not exclude these men from such surgery.

Sexualité féminine après chirurgie pour endométriose pelvienne profonde

ObjectivesThe aim of this study is to assess the impact on sexuality of the surgical treatment in patients with symptomatic deep pelvic endometriosis. Patients and methodsThe design is a single-center cohort prospective study including all patients with symptomatic pelvic endometriosis and regular sexual activity who underwent surgery between October 2009 and September 2010. Sexual function was evaluated by the “Brief Index of Sexual Functioning for Women” (BISF-W) questionnaire translated and validated in French, including a global evaluation by the Composite Score (CS). Pain symptoms related to endometriosis were evaluated by the Visual Analog Scale (VAS) and the simple Verbal Rating Scale (VRS). Questionnaires were answered before surgery. A standardized mid and long-term postoperative follow-up was performed to compare sexuality and pain symptoms. ResultsTwenty women were included in the study. Mean follow-up was 23.3 months. When compared to a French reference population, global preoperative sexual function was significatively deteriorated (CS=14.3±10.8 vs 32.2±12.6; P<0.001), especially for arousal, frequency of sexual activity, pleasure and orgasm. Significant improvements in sex life were observed after surgery at the long-term follow-up (CS=33.0±11.7 vs 14.3±10.8; P=0.02). and sexual function was similar to the reference population (CS=33.0±11.7 vs 32.2±12.6; P=0.806). At the mid-follow-up, a significant improvement in the intensity of dysmenorrhoea, non-cyclic pelvic pain, dyspareunia and bowel symptoms were observed on the VAS. At the long-term follow-up, dysmenorrhoea and dyspareunia were significatively ameliorated. Pelvic pain recurrence related to endometriosis was 13.3%. Discussion and conclusionSurgical management of deep pelvic endometriosis in symptomatic patients improves sexual life at the long term follow-up. Deep dyspareunia pain decreases significantly, although other conditions are involved in the improvement of sexual function.