Preoperative Sexual Function Research Articles

Sexual bother and function after radical prostatectomy: predictors of sexual bother recovery in men despite persistent post‐operative sexual dysfunction

Changes in sexual bother (SB) following radical prostatectomy (RP) negatively affect health-related quality of life (HRQoL) of prostate cancer survivors. However, post-operative SB tends to be neglected whereas sexual function (SF) is thoroughly assessed in clinical practice and few studies have focused on and evaluated patients' SB. We retrospectively reviewed 2 345 consecutive patients who underwent RP between 2001 and 2009 at a single institution. SF and SB were assessed using Expanded Prostate Cancer Index Composite (EPIC) questionnaires. We stratified our cohort by SB recovery and post-operative SF status, including a subset of men who recovered SB despite persistent post-RP sexual dysfunction. Multivariable logistic regression analyses were conducted to identify factors for men who have SB recovery. Of 319 eligible patients, 133 (41.7%) recovered their SB at a mean of 20 months after RP. Among the 133 men who demonstrated SB recovery, 109 had post-operative sexual dysfunction. Patients with SB recovery despite post-RP sexual dysfunction were more likely to be old (p = 0.004), to have higher clinical T stage (p < 0.001), to have more non-nerve-sparing RP (p < 0.001), to have lower pre-operative EPIC-SF/SB scores (p < 0.001), to have more extracapsular extension (p = 0.031) and to be PDE5i non-users after surgery (p < 0.001). In multivariable analysis, predictors for this subset were lower comorbidity (OR 0.62, p = 0.043), higher clinical cancer stage (OR 2.35, p = 0.026), worse pre-operative SF (OR 0.98, p = 0.010), SB (OR 0.98, p < 0.010) and no PDE5i use (OR 0.37, p = 0.002); age was not related (OR 0.99, p = 0.555). As SB can influence patients' overall HRQoL, expectations of SB recovery should be provided to patients in the same way that SF recovery is presented. This study may help clinicians to discuss SB with patients and assess their potential for SB recovery following RP.

Long-Term Satisfaction and Predictors of Use of Intracorporeal Injections for Post-Prostatectomy Erectile Dysfunction

Intracorporeal injections have low use rates and high discontinuation rates. We examined factors associated with intracorporeal injection use, long-term satisfaction with intracorporeal injection and reasons for discontinuation in men treated with radical prostatectomy. Between October 2000 and September 2003, 731 men who underwent open radical retropubic prostatectomy were enrolled in a prospective outcomes study. The 8-year followup evaluation included the UCLA-PCI, and a survey capturing intracorporeal injection use, satisfaction and reasons for discontinuation. Logistic regression was used to determine associations between intracorporeal injection use and preoperative variables. The 8-year self-assessment was completed by 368 (50.4%) men. Of these men 140 (38%) indicated prior or current intracorporeal injection use, with only 34 using intracorporeal injection at 8 years. Overall, 44% of the men were satisfied with intracorporeal injections. Reasons for discontinuation included dislike (47%), pain (33%), return of erection (19%), inefficacy (14%) and no partner (6%). Men trying intracorporeal injections had greater preoperative UCLA-PCI sexual function scores (75.2 vs 65.62, p = 0.00005) as well as greater decreases in this score at 3 months (p = 0.0002) and 2 years (p = 0.003). Higher preoperative sexual function scores were independently associated with the use of intracorporeal injections in a model adjusted for age, marital status, nerve sparing status and body mass index (OR 1.021, 95% CI 1.008-1.035). Men pursuing intracorporeal injections have better baseline erectile function and experience greater deterioration in erectile function during the early postoperative period. Despite the high efficacy of injections, many men discontinue intracorporeal injections due to dislike or discomfort. Satisfaction rates for intracorporeal injections indicate their long-term role in restoring sexual function in men with post-prostatectomy erectile dysfunction.

Predicting participation in and successful outcome of a penile rehabilitation programme using a phosphodiesterase type 5 inhibitor with a vacuum erection device after radical prostatectomy

Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? The role of the vacuum erection device (VED) has increased with its use in combined therapy with a phosphodiesterase type 5 inhibitor (PDE5i) for penile rehabilitation after radical prostatectomy (RP) and radiotherapy. The advantages of the VED are non-invasive, cost-effective, and a possibility of preventing shrinkage of penis length. Albeit current widespread use of penile rehabilitation programmes for post-RP erectile dysfunction, independent predictors for the rehabilitation participants, as well as for its treatment success have not been fully investigated. In the present study, we have added several new predictors for rehabilitation participation, e.g. African-Americans and higher preoperative sexual function. Conversely, higher preoperative PSA concentrations and the presence of positive surgical margins were predictors for avoidance of rehabilitation. Notably, there was a primary surgeon difference, which had a trend for predicting outcome of the rehabilitation among the participants, implying their surgical technique and follow-up might influence success of the rehabilitation. • To investigate baseline demographic and clinicopathological characteristics of men who participate in our penile rehabilitation programme after radical prostatectomy (RP). • To determine predictors for participation in rehabilitation, as well as successful rehabilitation outcome using multivariable logistic regression analyses. • We analysed data on 2345 consecutive patients who underwent RP between 2001 and 2009 in our institution. • The decision to participate in penile rehabilitation using phosphodiesterase type 5 inhibitor (PDE5i) with a vacuum erection device (VED) was based on the patient's choice after post-RP discussions. • Rehabilitation success was defined using the following criteria: (i) patients who continued the penile rehabilitation programme and did not switch treatment from PDE5i to other erectile aids, (ii) success was noted in men who had an Expanded Prostate Cancer Index Composite (EPIC) sexual function (SF) score of >75% of the patient's baseline EPIC score, and (iii) patients who answered that they achieved adequate erections with a PDE5i. • Logistic regression analysis was used to identify factors associated with treatment participation and its success. • Of 676 patients, 354 (53.2%) men participated in a penile rehabilitation programme. Among 329 rehabilitation participants with available data, 96 (29.2%) had treatment success. • In multivariable regression analysis, African-Americans (odds ratio [OR] 3.47, P < 0.001), and higher preoperative SF (OR 1.02, P < 0.001) were associated with participation in rehabilitation. • Higher preoperative PSA concentration (OR 0.50, P = 0.004) and presence of positive surgical margins (OR 0.68, P = 0.042) were found to be independent predictors for non-participation in the rehabilitation. • For rehabilitation outcomes, being older at surgery (OR 0.93, P = 0.001) and adjuvant therapy (OR 0.34, P = 0.047) had a negative association with successful outcome. • There was a trend in the relationship between primary surgeon and rehabilitation success (OR 1.05, P = 0.053) • Those patients who have risk factors, e.g. adverse prostate cancer features, need to be carefully counselled and encouraged to participate in the penile rehabilitation programme. • Clinicians could lead patients toward successful outcomes if appropriate surgical techniques and rehabilitation are provided.

1861 THE IMPACT OF VISUAL INTERNAL URETHROTOMY (VIU) ON SEXUAL FUNCTION

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Peyronie's Disease/Surgical Therapy II1 Apr 20121861 THE IMPACT OF VISUAL INTERNAL URETHROTOMY (VIU) ON SEXUAL FUNCTION Phil Hyun Song, Ji Woong Choi, Dae Hyeon Kwon, Hyun Tae Kim, Hong Seok Shin, Hee Chang Jung, and Ki Hak Moon Phil Hyun SongPhil Hyun Song Daegu, Korea, Republic of More articles by this author , Ji Woong ChoiJi Woong Choi Daegu, Korea, Republic of More articles by this author , Dae Hyeon KwonDae Hyeon Kwon Daegu, Korea, Republic of More articles by this author , Hyun Tae KimHyun Tae Kim Daegu, Korea, Republic of More articles by this author , Hong Seok ShinHong Seok Shin Daegu, Korea, Republic of More articles by this author , Hee Chang JungHee Chang Jung Daegu, Korea, Republic of More articles by this author , and Ki Hak MoonKi Hak Moon Daegu, Korea, Republic of More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1973AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We prospectively examined the impact of VIU on sexual function. METHODS Between March 2006 and April 2010, 76 patients treated by VIU were enrolled in this study. Preoperative sexual function was assessed by International Index of Erectile Function-5 (IIEF-5) and Intravaginal Ejaculation latency time (IELT). Nine patients who had IIEF-5 score<17 and IELT<2min were excluded. Sexual function was evaluated by the Korean version of the Male Sexual Health Questionnaire (MSHQ) assessing three sexual functional domains of ejaculation (range: 0-15), satisfaction (range: 6-30), erection (range: 1-35) at preoperative, 3 months, 6 months and 12 months after VIU. We assessed the etiology of stricture, stricture site, stricture length, time of recurrence, duration until first recurrence and compared respective scores for age groups (ranges 40-49, 50-59, 60-69, 70-79 years). Recurrence was diagnosed by retrograde urethrography. RESULTS A total of 67 men with mean age 57.1 (range 43-77) completed the study. The mean follow-up was 17.5 months (range 12-38). There were no significant differences in erectile function and sexual satisfaction for all age groups, but it improves ejaculatory function in 40-49 (p=0.012), 50-59 (p=0.018) age groups. The etiology of stricture was traumatic in 23 patients, inflammatory in 14 patients, idiopathic in 25 patients, iatrogenic in 5 patients. Stricture site was bulbous in 25 patients, membranous in 36 patients and multiple in 6 patients. The mean stricture length was 1.86±0.932cm, the mean time of recurrence was 1.5±0.74 times, the mean duration until first recurrence was 10.5±6.72 months. In univariate analysis, there were no significant differences in satisfaction, erectile function for all various factors. But, shorter length of stricture, smaller times of recurrence and shorter duration until first recurrence improved ejaculatory function (p=0.006, p=0.005, p=0.013). CONCLUSIONS VIU does not significantly affect erectile function and sexual satisfaction, but it improves ejaculatory function in younger age group. Shorter stricture length, smaller time of recurrence and shorter duration until first recurrence can improve ejaculatory function. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e752 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Phil Hyun Song Daegu, Korea, Republic of More articles by this author Ji Woong Choi Daegu, Korea, Republic of More articles by this author Dae Hyeon Kwon Daegu, Korea, Republic of More articles by this author Hyun Tae Kim Daegu, Korea, Republic of More articles by this author Hong Seok Shin Daegu, Korea, Republic of More articles by this author Hee Chang Jung Daegu, Korea, Republic of More articles by this author Ki Hak Moon Daegu, Korea, Republic of More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

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

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

166 SERUM SEX STEROIDS MEASURED IN MIDDLE-AGED FRENCH CAUCASIAN AND AFRICAN-CARIBBEAN MEN, KNOWN TO HAVE A DIFFERENT RISK OF PROSTATE CANCER, USING GAS CHROMATOGRAPHY-MASS SPECTROMETRY

Patients with average and high LIVE scores had higher sexual function scores than patients with low LIVE scores preoperatively (p 0.001), at 6 (p 0.01), 12 (p 0.013) and 24 months (p 0.036). Better erection quality (p 0.02) and orgasmic function (p 0.01) were positively associated with LIVE scores after adjustments for age, preoperative sexual function, and receipt of nerve sparing technique. There was no difference in pad count between LIVE groups at 6 and 12 months after adjustment for age and nervesparing technique. CONCLUSIONS: As demonstrated by the LIVE index, healthy lifestyle behaviors are associated with improved postoperative sexual function for patients undergoing RARP.

333 RADICAL RETROOUBIC PROSTATECTOMY VS ROBOT ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY A QUALITY OF LIFE COMPARISON

You have accessJournal of UrologyProstate Cancer: Epidemiology and Natural History II1 Apr 2012333 RADICAL RETROOUBIC PROSTATECTOMY VS ROBOT ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY A QUALITY OF LIFE COMPARISON John Gannon, Christopher Dechet, Robert Stephenson, Arthur Hartz, and Tao He John GannonJohn Gannon Salt Lake City, UT More articles by this author , Christopher DechetChristopher Dechet Salt Lake City, UT More articles by this author , Robert StephensonRobert Stephenson Salt Lake City, UT More articles by this author , Arthur HartzArthur Hartz Salt Lake City, UT More articles by this author , and Tao HeTao He Salt Lake City, UT More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.394AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate and compare the quality of life outcomes of patients undergoing radical retropubic prostatectomy (RRP) and Robotically Assisted Laparoscopic Radical Prostatectomy (RALRP). METHODS Eight hundred and thirty-six, non-randomized patients undergoing RRP or RALRP at one institution involving 2 surgeons were prospectively evaluated using the long form Expanded Prostate Cancer Index Composite (EPIC). Patients were evaluated preoperatively and post-operatively at 3, 6, 9, 12, 18, and 24 months. RESULTS Excluding patients with Stage >T3, Gleason score >7 and patients undergoing a non-nerve sparing procedure, 418 patients underwent RALRP and 421 patients underwent RRP by 2 surgeons. Significant differences existed between tumor grade, stage, Gleason score (p<0.05) and age; reflecting an institutional bias to select higher grade and higher volume tumors for RRP. No significant difference was noted in post-operative complications by clavian scores. Robotic surgery had no significant impact on EPIC urinary function scores. Age had a significant impact on post-operative urinary function. Of the 243 patients who had a nerve sparing procedure and adequate pre-operative sexual function, no significant difference was noted between robotic and open prostatectomy. Age and degree of nerve sparing had a significant impact on post-operative sexual function (p<0.05). CONCLUSIONS Our non-randomized prospective comparison of quality of life outcomes between patients undergoing RRP vs RALRP revealed no significant differences in post-operative urinary and sexual function scores. Robotic (N=415) Open (N=421) Age* 60.0(43 to 78) 62.1(44 to 79) Stage T2* 83.1% 65.8% Gleason Score* < 7 50.2% 34.8% Gleason Score 7 46.1% 51.2% Gleason Score > 7 3.62% 14.1% Prostate weight* 52 gm 60gm Obesity (BMI>30) 27.5% 29.6% © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e135-e136 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Gannon Salt Lake City, UT More articles by this author Christopher Dechet Salt Lake City, UT More articles by this author Robert Stephenson Salt Lake City, UT More articles by this author Arthur Hartz Salt Lake City, UT More articles by this author Tao He Salt Lake City, UT More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Technical Refinement and Learning Curve for Attenuating Neurapraxia During Robotic-Assisted Radical Prostatectomy to Improve Sexual Function

BackgroundWhile radical prostatectomy surgeon learning curves have characterized less blood loss, shorter operative times, and fewer positive margins, there is a dearth of studies characterizing learning curves for improving sexual function. Additionally, while learning curve studies often define volume thresholds for improvement, few of these studies demonstrate specific technical modifications that allow reproducibility of improved outcomes. ObjectiveDemonstrate and quantify the learning curve for improving sexual function outcomes based on technical refinements that reduce neurovascular bundle displacement during nerve-sparing robot-assisted radical prostatectomy (RARP). Design, setting, and participantsWe performed a retrospective study of 400 consecutive RARPs, categorized into groups of 50, performed after elimination of continuous surgeon/assistant neurovascular bundle countertraction. Surgical procedureOur approach to RARP has been described previously. A single-console robotic system was used for all cases. Outcome measurements and statistical analysisExpanded Prostate Cancer Index Composite sexual function was measured within 1 yr of RARP. Linear regression was performed to determine factors influencing the recovery of sexual function. Results and limitationsGreater surgeon experience was associated with better 5-mo sexual function (p=0.007) and a trend for better 12-mo sexual function (p=0.061), with improvement plateauing after 250–300 cases. Additionally, younger patient age (both p<0.02) and better preoperative sexual function (<0.001) were associated with better 5- and 12-mo sexual function. Moreover, trainee robotic console time during nerve sparing was associated with worse 12-mo sexual function (p=0.021), while unilateral nerve sparing/non–nerve sparing was associated with worse 5-mo sexual function (p=0.009). Limitations include the retrospective single-surgeon design. ConclusionsWith greater surgeon experience, attenuating lateral displacement of the neurovascular bundle and resultant neurapraxia improve postoperative sexual function. However, to maximize outcomes, appropriate patient selection must be exercised when allowing trainee nerve-sparing involvement.

Preoperative Erectile Function Represents a Significant Predictor of Postoperative Urinary Continence Recovery in Patients Treated With Bilateral Nerve Sparing Radical Prostatectomy

The association between baseline functional status and urinary continence recovery after radical prostatectomy remains controversial. We tested the hypothesis that baseline erectile and urinary function predicts urinary continence recovery after bilateral nerve sparing radical prostatectomy. The study included 752 patients with prostate cancer treated with bilateral nerve sparing radical prostatectomy between 2003 and 2009. All patients had preoperative functional and oncological data available, including age at surgery, body mass index, prostate specific antigen, and erectile and urinary function. Preoperatively erectile and urinary function was assessed by the erectile function domain of the International Index of Erectile Function and the International Prostatic Symptoms Score. Urinary continence was defined as wearing no pads. Univariate and multivariate Cox regression models were used to test the association between predictors and urinary continence recovery after surgery. At a mean postoperative followup of 30.7 months (median 29, range 1 to 80) 611 patients (81.3%) had recovered urinary continence. Overall the urinary continence recovery rate at 1 and 3 years was 73.9% and 82.2%, respectively. On univariate Cox regression analysis patient age and the preoperative score on the erectile function domain of the International Index of Erectile Function were significantly associated with urinary continence recovery (each p ≤ 0.04). On multivariate analysis age at surgery and the preoperative erectile function domain of the International Index of Erectile Function were the only independent predictors of urinary continence recovery after bilateral nerve sparing radical prostatectomy (each p ≤ 0.04). Age and preoperative erectile function should be considered for urinary continence predictions after bilateral nerve sparing radical prostatectomy and for accurate patient counseling before surgery. Preoperative erectile function might be a marker of pelvic vascular disease, which may affect the status of the external urinary sphincter.

Postoperative Sexual Function

Rectal resection may impact the sexual function of both men and women. Postoperative sexual dysfunction occurs in as many as 60% of patients, depending upon the specific symptom studied. Studying the issue is complex because the underlying disease process, surgical technique, need for a stoma, adjuvant therapy, and preoperative sexual function all affect postoperative sexual function. The quality of the literature is limited by the lack of studies in which the authors use validated instruments. Even in that context, information on female patients is more limited than data on male patients. Improvements in surgical technique may help reduce postoperative sexual dysfunction while more complete information would improve patient counseling.

Experience with intracavernous injection in the treatment of erectile dysfunction after radical prostatectomy: dose considerations

We sought to identify factors influencing dose maintenance of intracavernous (IC) injection among patients with ED following radical prostatectomy. A total of 93 patients underwent prostatectomy and received IC treatment for ED, including PGE1 single therapy (n=53) and triple therapy (n=40). In the PGE1-only group, the maintenance dosage was significantly correlated with preoperative sexual function and nerve sparing (NS) (P<0.05). For example, the maintenance dose among patients with no, unilateral and bilateral NS was 10.8 ± 6.6 μg (0.54 ± 0.33 ml), 10.8 ± 3.8 μg (0.54 ± 0.19 ml) and 6.4 ± 4.6 μg (0.32 ± 0.23 ml), respectively. In terms of preoperative sexual function, the maintenance dose among non-ED versus ED patients was 0.38 ± 0.25 ml (7.6 ± 5.0 μg) and 0.59 ± 0.31 ml (11.8 ± 6.2 μg), respectively. No significant correlation was observed between the maintenance dose and NS or preoperative sexual function among the triple-therapy patients or between the maintenance dose and age, body mass index, systemic diseases and initiation of ED treatment among all patients (P>0.05). Thus, maintenance dose of PGE1 therapy could be partly determined by NS status and prior ED of patients.

The Female Factor: Predicting Compliance with a Post-Prostatectomy Erectile Preservation Program

Early post-radical prostatectomy (RP) erectile preservation (EP) therapy may be critical to preserve erections after surgery. To assess if pre-RP female sexual function predicts of partner compliance with an EP protocol. Compliance, defined as use of localized penile EP therapy (intracavernosal injections [ICIs], vacuum erection device [VED], or alprostadil) at 3 and 6 months after RP. Records of patients enrolled in our EP program from April 2007 to June 2008 were reviewed. Before surgery, patients completed the Sexual Health Inventory for Men (SHIM) and their female partners completed the Female Sexual Function Index (FSFI) questionnaire. Prior to surgery, patients were advised to take sildenafil 25 mg every nightly and use a 250-µg alprostadil suppository three times/week. At 1 month, additional daily use of a VED was encouraged. All patients unable to achieve erections sufficient for penetration were encouraged to initiate ICI of Trimix (phentolamine, papaverine, and PGE1) twice weekly after 3 months following surgery. Data were analyzed using binary logistic regression analysis holding all input variables constant. Twenty-nine patients had preoperative SHIM>7 and pre-RP partner FSFI data available. After a 4-week follow-up, compliance with alprostadil suppository declined and both ICI and VED usage increased. At 6 months, six (25.0%) patients had return of natural erectile function and 22 (91.7%) were achieving assisted erections. Higher preoperative partner FSFI scores were associated with greater compliance to the localized penile therapy component of our EP protocol (risk ratio 3.8, P=0.05). Preoperative female sexual function correlated with greater partner compliance with the localized component of our EP protocol. Consideration of a female partner's preoperative sexual function in predicting patient erectile function recovery after RP is warranted. Future studies are necessary to determine the clinical significance of this factor.

Significant resolution of female sexual dysfunction after bariatric surgery

Background We have previously reported that most women seeking bariatric surgery have had female sexual dysfunction (FSD) as defined by the validated Female Sexual Function Index (FSFI). The present study examined whether FSD resolves after bariatric surgery. Methods A total of 54 reportedly sexually active women (43.3 ± 9.5 years) completed the FSFI preoperatively and 6 months postoperatively after a mean percentage of excess weight loss of 42.3% (laparoscopic adjustable gastric banding [n = 38], percentage of excess weight loss, 34.6% ± 15.7%; Roux-en- Y gastric bypass [n = 16], percentage of excess weight loss 60.0% ± 21.2%). The FSFI assesses sexual function across 6 domains, with higher scores indicating better sexual function. The summing of these scores yields a FSFI total score (range 2–36, with a score of ≤26.55 indicating FSD). Results Before surgery, 34 women (63%) had scores indicative of FSD. By 6 months postoperatively, the FSD had resolved in 23 (68%) of these 34 women, and only 1 woman had developed FSD postoperatively. In the entire sample, significant ( P < .05) improvements occurred from before to after surgery on all FSFI domains. The FSFI total scores improved after laparoscopic adjustable gastric banding (from 24.2 ± 5.9 to 29.1 ± 4.1, P < .001) and Roux-en- Y gastric bypass (from 23.7 ± 7.7 to 30.0 ± 4.7, P < .001). In regression analyses, being married, younger age, and worse preoperative sexual function were related to greater sexual function improvements. Postoperatively, the participants' FSFI total scores were indistinguishable from those of published normative controls (29.4 ± 4.3 versus 30.5 ± 5.3, P = .18). Conclusion FSD resolved in a large percentage of women after bariatric surgery. Sexual functioning in the entire sample improved to levels consistent with those of normative controls. This improvement in sexual function did not depend on surgery type or weight loss amount and appears to be an additional benefit for women undergoing bariatric surgery.

A Large Multicenter Outcome Study of Female Genital Plastic Surgery

Female Genital Plastic Surgery, a relatively new entry in the field of Cosmetic and Plastic Surgery, has promised sexual enhancement and functional and cosmetic improvement for women. Are the vulvovaginal aesthetic procedures of Labiaplasty, Vaginoplasty/Perineoplasty ("Vaginal Rejuvenation") and Clitoral Hood Reduction effective, and do they deliver on that promise? For what reason do women seek these procedures? What complications are evident, and what effects are noted regarding sexual function for women and their partners? Who should be performing these procedures, what training should they have, and what are the ethical considerations? This study was designed to produce objective, utilizable outcome data regarding FGPS. 1) Reasons for considering surgery from both patient's and physician's perspective; 2) Pre-operative sexual functioning per procedure; 3) Overall patient satisfaction per procedure; 4) Effect of procedure on patient's sexual enjoyment, per procedure; 5) Patient's perception of effect on her partner's sexual enjoyment, per procedure; 6) Complications. This cross-sectional study, including 258 women and encompassing 341 separate procedures, comes from a group of twelve gynecologists, gynecologic urologists and plastic surgeons from ten centers in eight states nationwide. 104 labiaplasties, 24 clitoral hood reductions, 49 combined labiaplasty/clitoral hood reductions, 47 vaginoplasties and/or perineoplasties, and 34 combined labiaplasty and/or reduction of the clitoral hood plus vaginoplasty/perineoplasty procedures were studied retrospectively, analyzing both patient's and physician's perception of surgical rationale, pre-operative sexual function and several outcome criteria. Combining the three groups, 91.6% of patients were satisfied with the results of their surgery after a 6-42 month follow-up. Significant subjective enhancement in sexual functioning for both women and their sexual partners was noted (p = 0.0078), especially in patients undergoing vaginal tightening/perineal support procedures. Complications were acceptable and not of major consequence. While emphasizing that these female genital plastic procedures are not performed to correct "abnormalities," as there is a wide range of normality in the external and internal female genitalia, both parous and nulliparous, many women chose to modify their vulvas and vaginas. From the results of this large study pooling data from a diverse group of experienced genital plastic surgeons, outcome in both general and sexual satisfaction appear excellent.

Sacrifice of Accessory Pudendal Arteries in Normally Potent Men during Robot-Assisted Radical Prostatectomy Does Not Impact Potency

Whether or not sacrificing accessory pudendal arteries (APAs) during radical prostatectomy affects potency has been an ongoing source of concern. Herein, we present our potency results relative to sacrificing APAs in normally pre-potent men following robot-assisted radical prostatectomy (RARP). The distribution of APAs and clinical characteristics were prospectively recorded in 200 consecutive patients undergoing RARP with a cautery-free technique. Sexual function was assessed using the International Index of Erectile Function 5-item questionnaire (IIEF-5). All APAs were sacrificed due to stapling the dorsal vein complex. Postoperatively, potency was defined by an affirmative answer to the following two questions: "Were erections adequate for penetration?" and "were the erections satisfactory?" Postoperative IIEF-5 scores and quality of erections (% of preoperative firmness: 0%, 25%, 50%, 75%, 100%) were also obtained. Subgroup analysis of patients age < or =65 years with IIEF-5 score of 22-25 was performed. Eighty patients (40%) had APAs. Preoperatively, there was no association with having an APA and normal/abnormal sexual function. Preoperatively, 58/200 were < or =65 years with self-administered IIEF-5 scores of 22-25. Postoperatively, 53/58 (91%) were potent at 24 months follow-up. Nineteen of 58 patients had a sacrificed APA; 39 patients had no APA. Eighteen of 19 (95%) patients with sacrificed APAs were potent vs. 35/39 (90%) with no APA present (P = 0.53). Multivariate analysis showed no significant correlation between sacrificing an APA and time of potency recovery, quality of postoperative erections (94% vs. 90% P = 0.80) or mean IIEF-5 score (22.4 vs. 20.8, P = 0.13). We found no correlation between the presence or absence of APAs and preoperative sexual function. Furthermore, after sacrificing all APAs, we found no correlation with potency return, time to return of potency, quality of erections, or mean IIEF-5 scores at 24 months.

Unsuccessful Investigation of Preoperative Sexual Health Issues in the Prostate Cancer “Couple”: Results of a Real‐Life Psychometric Survey at a Major Tertiary Academic Center

Investigating preoperative sexual function of patients with prostate cancer (PCa) and their partners is needed for realistic functional outcome analyses after radical prostatectomy (RP). To assess pre-RP sexual health issues of PCa patients and their partners in a stable heterosexual relationship. Data were analyzed from 3,282 consecutive patients who underwent RP over a three-period survey. During Period 1, on admission to the hospital the day prior to surgery, 1,360 patients were asked to complete the International Index of Erectile Function (IIEF). During Period 2, 1,171 patients were asked to complete the preoperative IIEF; similarly, patients' partners were invited to complete the Female Sexual Function Index (FSFI). Lastly, during Period 3, only candidates for RP were asked to fill in the IIEF. To assess the rate of patients who completed the questionnaire during the three-period survey. To detail the proportion of patients' partners who filled in the questionnaire, along with the partners' reasons for non-adherence to the proposed investigation during Period 2. A small rate of men completed the IIEF during Period 1 (583 in 1,360 [42.9%]), Period 2 (290 in 1,171 [24.8%]), and Period 3 (261 in 751 [34.8%]) (chi(2) trend: 13.06; P = 0.0003). In this context, a significantly lower proportion of patients completed the questionnaire during Period 2, as compared with both Period 1 (chi(2): 95.13; P = 0.0001) and Period 3 (chi(2): 21.87; P < 0.0001). Only 82 in 1,171 (7.0%) partners completed the FSFI over Period 2. Moreover, only 6 in 82 (7.3%) of women provided complete data. The investigation of sexual health issues of both partners prior to RP is largely unsuccessful. In this context, the prevalence of incomplete data collection is high, and these results demonstrate that contemporaneously investigating the sexual health issues of both partners significantly increases the prevalence of incomplete data collection.

Changes in Sexual Function after Mid-Urethral Tape Sling Operations for Stress Urinary Incontinence in Korean Women

Purpose: We assessed sexual function by using a questionnaire in women who were diagnosed with stress urinary incontinence and underwent mid-urethral tape sling surgery. Materials and Methods: A retrospective survey was conducted of 151 women without evidence of detrusor overactivity or concomitant prolapse who underwent surgery (tension-free vaginal tape or tension-free vaginal tape-obturator) for stress urinary incontinence. The participants filled out a questionnaire regarding their preoperative and 6-month postoperative sexual function. Paired t-tests were used to compare changes over time. The generalized McNemar test was used to compare individual preoperative and postoperative findings. We considered a p-value less than 0.05 as significant. Results: Of the 303 women who fulfilled the inclusion criteria, 204 (67.3%) returned the questionnaire. Of those 204 women, 151 were sexually active before and after surgery. No significant differences were observed after surgery in the frequency or appreciation of intercourse or the extent of sexuality. A significant reduction in leakage symptoms was observed after surgery (p<0.01). Of the 151 women, 29 (19.2%) reported an improvement in satisfaction with intercourse and 23 (15.2%) reported a deterioration after the anti-incontinence procedure. Partner discomfort remained unchanged. Of the 151 patients, 26 (17.2%) patients were unsatisfied with the surgical outcome because of persistence or recurrence of stress urinary incontinence and deterioration in satisfaction with intercourse after surgery. Conclusions: These results suggest that mid-urethral tape sling operations for stress urinary incontinence improved the continence rate, but had little effect on preexisting sexual disturbances. Additional and larger retrospective studies are warranted to support these preliminary findings. (Korean J Urol 2009;50:908-915) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Skinning clitorectomy and skin replacement in women with vulvar intra-epithelial neoplasia

Partial or total clitoris amputation for vulvar intra-epithelial neoplasia (VIN) affects quality of life and sexual function and is likely to constitute over-treatment as superficial excision of only the involved, thinly cornified, stratified squamous clitoral epithelium would suffice. For this reason, we applied skinning clitorectomy and replacement of clitoral skin as an organ-sparing surgical therapy for clitoral VIN. Seven consecutive patients presenting with VIN were treated from July 2003 to February 2008. The skin of the glans clitoridis was resected from the underlying spongious tissue by combined hydro-dissection and sharp dissection. The spongiosum was subsequently covered with either a thin skin flap from the inner aspect of the remaining preputium or minor labium, or a split-thickness skin graft taken from the proximal inner aspect of the thigh. In all patients, the preoperative diagnosis of VIN was confirmed histopathologically. Additionally, micro-invasive carcinoma was found in two. The postoperative course was complicated by haematoma in one patient and a superficial infection in another, but these did not influence the overall satisfactory outcome obtained in all patients. Preoperative sexual function was largely preserved and, after a mean follow-up of 21 months, no recurrence or invasion of the original lesion was observed in any of the patients. We advocate skinning clitorectomy and replacement of its skin as a sound organ-sparing alternative for clitoral amputation in the treatment of clitoral VIN.

Single Institution 2-Year Patient Reported Validated Sexual Function Outcomes After Nerve Sparing Robot Assisted Radical Prostatectomy

To identify surgeon specific factors for preserving sexual function (and minimize patient related factors) we report 2-year potency outcomes in men 65 years or younger with normal preoperative sexual function undergoing nerve sparing robot assisted laparoscopic radical prostatectomy. Between July 2004 and February 2006, 200 consecutive patients underwent robot assisted laparoscopic radical prostatectomy by 1 surgeon. Inclusion criteria were age 65 years or younger with normal baseline 5-item International Index of Erectile Function score of 22 to 25 and complete 2-year followup. Postoperatively potency was defined by a yes to "erections adequate for vaginal penetration" and "satisfactory erections" on prospective self-administered validated questionnaires with or without phosphodiesterase type 5 medications. Men also reported 5-item International Index of Erectile Function scores and erectile fullness of 0% to 10%, 25%, 50%, 75% or 100% compared to before surgery. A total of 62 patients met the inclusion criteria, and of these 3 were lost to followup and 1 was excluded from study due to receiving hormonal therapy. At 3 months 32.1% reported potency. At 24 months potency was 89.7% (52 of 58) overall, 93.0% (40 of 43) for bilateral and 80.0% (12 of 15) for unilateral nerve sparing. For potent men the mean 5-item International Index of Erectile Function score was 20.4 at 3 months vs 21.3 at 24 months. Mean erectile firmness at 24 months was 91% compared to preoperative baseline, with 34 of 52 (65%) reporting 100% of preoperative fullness. The 5-item International Index of Erectile Function score and fullness at 24 months were equivalent for unilateral nerve sparing and bilateral nerve sparing. Overall 90% of men reported return of potency at 24 months, and 46% returned to baseline with normal 5-item International Index of Erectile Function scores and 100% firmness. Remarkably there was no difference in 5-item International Index of Erectile Function scores or fullness between unilateral nerve sparing and bilateral nerve sparing.

Remembered International Index of Erectile Function Domain Scores Are Not Accurate in Assessing Preoperative Potency in Candidates for Bilateral Nerve-Sparing Radical Retropubic Prostatectomy

The reliability of reported postoperative data in patients undergoing nerve-sparing radical retropubic prostatectomy is often limited because the degree of sexual function (SF) has not been assessed objectively both before and after treatment. Most reports include only a retrospective chart review, and there is a question of whether such data are accurate. To test the agreement between a remembered International Index of Erectile Function (IIEF) score, which targeted SF regarding a period preceding the surgery by 6 months and a real-time IIEF, 4 weeks prior to surgery, in candidates for bilateral nerve-sparing radical retropubic prostatectomy (BNSRRP). From May 2005 to May 2006, 333 consecutive patients were candidates for BNSRRP at our institution. Upon admission on the day prior to surgery, each patient was asked to complete a set of validated questionnaires including both a remembered and a real-time IIEF. Two-tailed Student's t-test, chi2 test, Pearson correlation coefficient, multivariate regression analyses, and interrater agreement (kappa) were used to test the agreement between the two assessments. Assessing the preoperative SF characteristics of candidates for a BNSRRP, and testing the reliability of a remembered IIEF with the interrater agreement (kappa) test. Mean scores for the remembered IIEF were overall better than the real-time IIEF scores, as supported by direct comparison of the mean IIEF domain scores. Univariate correlation analysis and multivariate regression analysis indicated a significant correlation in the quality of the SF during the two periods. However, the remembered IIEF scores did not show a good statistical agreement with those of the real-time assessment, as demonstrated by the interrater agreement analysis. Because of the lack of significant agreement between remembered and real-time IIEF scores, the present findings indicate that remembered IIEF should not be used to assess SF in a real-life clinical setting in candidates for BNSRRP.