Sexual Function Satisfaction Research Articles

Oncologic and functional outcomes following robot assisted radical prostatectomy: 15-Year experience in a Latin American referral center

BackgroundProstate cancer is the most common cancer in men with more than 52,000 cases diagnosed every year on average. With the introduction of robotic surgery, robotic assisted radical prostatectomy (RARP) has become a popular treatment option in recent years. Achieving oncological control, urinary continence and satisfactory erectile sexual function after RP is the main goal also known as “trifecta”. All these outcomes are highly influenced by surgical experience and caseload. The main objective of this study is to analyze oncological and functional outcomes in RARP after 15 years of experience. MethodsFrom 2008 until December 2023, 1790 RARP for localized prostate cancer were performed. A retrospective analysis was conducted based on prospectively collected data correlated with electronic medical records. ResultsSubgroup analyses were conducted in order to evaluate oncological and functional outcomes (n: 1400). Red blood cell transfusion and conversion to open surgery rate was 1.9 % and 0.1 %, respectively. Mean surgical time was 194 min. Mean follow-up time was 69.5 months, 23.8 % patients experienced biochemical recurrence and 1 % died, primarily due to disease progression. Estimated 10-year recurrence-free survival was 68.7 % (95 % CI 67.2–72.2) while estimated 10-year overall survival was 97.9 % (95 % CI 96.3–99.4). Overall urinary continence rate at 2 years was 86.9 % while satisfactory erectile function rate at 18 months was 56.8 %. ConclusionsRobotic-assisted radical prostatectomy has become a standard surgical technique in our urological practice for the management of clinically localized and locally advanced prostate tumors in selected cases. After 15 years since the inception of our robotic surgery program, we can conclude that our results are comparable to those published in the international literature, enabling patients to maintain satisfactory sexual function with a high continence rate within the first year of surgery.

Sexual function, quality of life, anxiety, and depression in women of reproductive age using hormonal, nonhormonal, and no contraceptive methods.

Hormonal contraceptive use has been related to adverse effects, including impacts on sexual function and sexual satisfaction, although the difference in the effects on sexual function with the use of hormonal vs nonhormonal contraceptive methods remains controversial. In this study we sought to compare the prevalence of dyspareunia, sexual function, sexual satisfaction, quality of life, anxiety, and depression between women using hormonal, nonhormonal, or no contraceptive methods and to compare these outcomes between the most frequently used contraceptive methods. This cross-sectional study included sexually active women of reproductive age who were stratified into 3 groups: women using hormonal, nonhormonal, or no contraceptive methods. Based on the use of questionnaires administered to the study participants, we compared sexual function in the 3 groups and more specifically among users of oral contraceptives, copper and hormonal intrauterine devices, and barrier methods. Participants completed 4 questionnaires to assess sexual function (Female Sexual Function Index), sexual satisfaction (Sexual Quotient-Feminine Version), quality of life (12-item Medical Outcomes Short Form Health Survey), and anxiety and depression (Hospital Anxiety and Depression Scale). This study included 315 women classified into 3 groups on the basis of contraceptive use: 161 in the hormonal contraceptives group (median [interquartile range] age, 24 [23-28] years), 97 in the nonhormonal contraceptives group (age 26 [23-30] years), and 57 in the no contraceptive methods group (age 28 [24-35] years). Dyspareunia prevalence showed no difference between the groups. In the quality of life domain, compared with women in the nonhormonal contraceptive group, women in the hormonal contraceptive group were younger and had lower sexual function satisfaction, reduced arousal, and heightened pain (P< .05), as well as higher anxiety and depression levels (P= .03, for both), increased pain (P= .01), and poorer overall health (P= .01). No difference was found between these groups in other quality of life domains. Regarding contraceptive methods, women using copper intrauterine devices had better sexual function, including higher rates of arousal and lower anxiety, than women using oral contraceptives (P< .05). The results of this study highlight worse sexual function and sexual satisfaction and higher levels of anxiety and depression in women using hormonal contraceptive methods than in women using nonhormonal methods. The findings of this study strengthen the evidence of differences in sexual function between women using oral contraceptives and those using copper intrauterine devices. Sexual function was also compared among users of oral contraceptives, copper and hormonal intrauterine devices, and barrier methods. However, less frequently used contraceptive methods, such as hormonal injections and vaginal rings, could not be compared in this sample. Women using hormonal contraceptive methods were younger, had lower sexual function and satisfaction, and experienced higher anxiety and depression levels than women using nonhormonal contraceptive methods.

Functional outcome and analysis of factors affecting health-related quality of life of surgically managed pelvic ring fractures: a cross-sectional study.

Pelvic ring fractures, particularly those involving the posterior pelvis, pose significant challenges due to their inherent instability. The posterior pelvic ring is critical in providing structural support and stability to the pelvis. This study evaluates the functional outcomes and health-related Quality of life (HRQOL) of patients who underwent internal fixation for unstable pelvic fractures. Various factors influencing the outcomes are also investigated. A single-center cross-sectional study was conducted on patients with unstable sacral fractures treated with posterior tension band plate or sacroiliac plating with or without symphyseal plating between 2016 and 2020. Patient demographics, injury mechanisms, associated injuries, surgical details, complications, and return-to-work data were collected. HRQOL was assessed using specific pelvic fracture instruments and general HRQOL questionnaires. Logistic regression analysis was performed to identify factors associated with lower SF-12 and SF-36 scores RESULTS: The study included 54 patients, predominantly males (55.6%), aged 18-70 years, with high-energy trauma mechanisms, such as road traffic accidents and occupational injuries. The majority of patients had lateral compression pelvic fractures. Overall, the functional outcomes were favorable, with excellent or good outcomes observed in 86.1% of cases. Patients with associated injuries, such as abdominal, chest, or head injuries, were likelier to have lower SF-12 physical component scores. Sexual satisfaction scores remained stable for most patients post-surgery. This study highlights the favorable functional outcomes and HRQOL for patients undergoing fixation for unstable pelvic ring fractures. Younger, working-age males were the most commonly affected demographic. Associated injuries significantly affected physical HRQOL scores. Despite high-energy trauma, patients generally reported satisfactory sexual function post-surgery.

Long-Term Bowel Vaginoplasty With a Single Yang-Monti Tube.

The bowel remains the favored tissue for neo-vaginoplasty (NeoVP) in pediatric patients with vaginal agenesis. In 2001, the first description of NeoVP using the Yang-Monti technique with a sigmoid double tubular flap was published. We present our experience of NeoVP with a single Yang-Monti tube (SYMT) flap and report on the use of different segments of colon. We conducted a retrospective review of patients who underwent NeoVP using a bowel SYMT between 2009 and 2021. The procedure was performed under open abdominal surgery by isolating 8 to 12 cm from the rectosigmoid, cecum, or ascending colon. Subsequently, this segment was detubularized near the mesenteric border, folded, and retubularized transversally, leaving the mesentery in a cephalic position. A channel was dissected in the pelvis to accommodate the NeoVP. Seventeen patients were identified. The median age was 16 years old. The principal diagnosis was Mayer-Rokitansky's syndrome (47.1%). The median follow-up was 50 months. The mean harvested bowel length was 9 cm, and the sigmoid was the preferred site (65%). The cecum-ascending colon was used in 3 (17.6%) patients. Complications were recorded in 6 patients (35%). Of these 6 patients, 4 had introital stenosis. There was 1 case of urethrovaginal fistula and another of left hematometrocolpos. Satisfactory sexual function has been reported in sexually active individuals. We described our experience in NeoVP using a large bowel SYMT as a safe and effective technique. It allows decreased tension on the vascular pedicle and the use of shorter colon segments.

Impact of COVID-19 on the sexual function and self-esteem of young Brazilian undergraduate students

Introduction: Satisfactory sexual function contributes considerably to women's physical and mental health and is affected by several factors, including chronic stress. Since the beginning of the COVID-19 pandemic, these stressors have been intensified by fear of contamination and morbidity and mortality, deaths, and long-term social isolation. Objective: To evaluate the effect of the COVID-19 pandemic on the sexual function and self-esteem of young women attending university in Brazil and also investigate the importance of social isolation in these conditions. Methods: This longitudinal study included 90 students with active sexual life who answered questionnaires before (in person) and during (virtually) the pandemic. The instruments used were the Female Sexual Function Index (FSFI) and the Rosenberg Self-Esteem Scale. Results: Only 67 women answered all questionnaires sent during the pandemic and had a mean age of 22.9 (±2.99) years; most of them were eutrophic, healthy students and, had a fixed partner. The total FSFI score allowed us to classify women without sexual dysfunction and was not modified during the pandemic. On the other hand, the self-esteem found was slightly lower than that considered healthy and did not change during the pandemic. Women who maintained social distancing showed a statistically significant reduction in sexual function when compared to those who did not (p=0.003). Conclusion: The COVID-19 pandemic did not influence young women’s sexual function or self-esteem attending university in Brazil. However, the behavior of social isolation during the pandemic impaired the sexual function of these women.

Effect of intervention based on the 5A self-management model on the improvement of behaviors related to women's reproductive health after legal abortion

Legal abortion has adopted many beneficial measures to prevent the birth of fetuses with congenital anomalies and maintain the health of high-risk mothers. However, abortion has its own complications and, thus, most mothers need care in this regard. The aim of this study was to determine the effect of self-management model on behaviors related to the reproductive health of mothers after legal abortion. This clinical trial study was conducted on 72 women who had legal abortion with the permission from Isfahan forensic medicine. The intervention was conducted using the 5A self-management model. The control group received the usual health system cares. Data collection tool was a researcher-made questionnaire of behaviors related to reproductive health, which was completed before and two months after the intervention by the two groups. The total mean score of the behavior (P < 0.001) and its dimensions (Prevention of post-abortion complications with P = 0.01, Prevention of sexually transmitted infections, satisfactory sexual function and family planning with P < 0.001) in the intervention group two months after the outset of the intervention was significantly higher than before the intervention. The total mean score of the behavior (P < 0.001) and its dimensions (Prevention of post-abortion complications with P = 0.002, Prevention of sexually transmitted infections, satisfactory sexual function and family planning with P < 0.001) two months after the outset of the intervention in the intervention group was significantly higher than the control group. Based on the results, this educational model can be emphasized to promote reproductive health behaviors of women after abortion.Clinical trial protocol link: https://www.irct.ir/user/trial/55184/view.

(133) Ambigous Genitalia in a 22 year old woman: A Case Report of Successful Perineoplasty and Clitoroplasty

Abstract Introduction External genitalia are considered to be ambiguous whenever there is difficulty assigning gender to a child based on the appearance of the external genitalia. It is a common presentation of Disorders of Sexual Development (DSD). Objective Reported here is the case of a 22year old single undergraduate identified as female who had disorder of sexual development with ambiguous genitalia resulting from congenital adrenal hyperplasia. Methods Although the appearance of her genitalia in childhood could not be ascertained, she presented with inability to achieve penetrative vagina intercourse, enlarged clitoris with dissatisfaction and distress about the appearance of her genitals, poor urinary stream and terminal dribbling. On examination she had clitoromegaly with fused labia minora at the midline which formed anterior to the urethral meatus as shown in Fig 1.1. She had acne and hirsutism. Investigations done show hyperandrogenism and were suggestive of congenital adrenal hyperplasia with no salt wasting. Results She had successful perineoplasty and clitoroplasty with satisfactory appearance of her genitalia, she has been able to achieve penetrative vagina intercourse with satisfactory sexual function and urinary streams have improved with terminal dribbling resolved. Conclusions Disorders of sexual developments though rare may have significant psychosocial effects on its victims and understanding the pathology with surgical intervention as indicated in this case may be helpful to improve the quality of life of the affected persons. Disclosure No

Retrospective comparative cohort study of neovagina creation by modified Vecchietti-laparoendoscopic single-site surgery for Mayer-Rokitansky-Küster-Hauser syndrome.

Although traditional multi-incision laparoscopic surgery is minimally invasive, it can still leave surgical scars on the lower abdomen. This study reports a modified Vecchietti-laparoendoscopic single-site (MVLESS) procedure using self-made instruments to create a neovagina for Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) and to determine the efficacy and safety. We conducted a retrospective comparative cohort study analysis of the clinical data from MRKHS patients treated in the Department of Difficult Gynecological Disease at Xi'an People's Hospital between January 2010 and December 2020.Women who were diagnosed with MRKHS and underwent a MVLESS procedure using self-made instruments to create a new vagina were selected as the study group (n=14). Patients who underwent a traditional multi-incision Vecchietti (TMV) procedure were selected as the control group (n=22). All participants in both groups were required to complete a Female Sexual Function Index (FSFI) and Female Genital Self-Image Scale (FGSIS) questionnaire. All patients in the study group were diagnosed with type I MRKHS and 3 (21.43%) were sexually active. Twenty-one patients in the control group were diagnosed with type I (95.45%) MRKHS, 1 (4.55%) had type II MRKHS (absent left kidney), and 6 (27.27%) were sexually active. The neovaginas in both groups were wide with good elasticity, softness, smoothness, and lubrication. There were no significant differences in operative time (37±6 vs. 39±4 minutes, P=0.98), intraoperative bleeding (28.32±9.82 vs. 29.45±3.84 mL, P=0.86), postoperative anal exsufflation time (18±4 vs. 20±4 hours, P=0.82), and postoperative hospital stay (7±2 vs. 8±2 days, P=0.84) between the MVLESS and TMV groups. The FSFI and FGSIS scores in both groups showed participants had a good quality of sexual life based on the 12-month follow-up data; however, sexual function was significantly better in the study group than in the control group [lubrication (4.72±0.86 vs. 4.64±1.01, P=0.023), visual analog scale (VAS; 4.26±0.52 vs. 4.45±0.39, P=0.041), total FSFI scores (30.21±4.32 vs. 28.42±2.21, P=0.048), and FGSIS score (23.21±1.98 vs. 22.14±2.04, P=0.012)]. The MVLESS procedure is a simple, safe, and minimally invasive procedure that provides an anatomical and functional neovagina for MRKHS patients. It is an alternative method for creating a neovagina to achieve satisfactory anatomic and sexual function. However, it is still a difficult problem to solve fertility problems for patients with congenital absence of vagina.

Anal Sex and Sexual Function Satisfaction: A Comprehensive (and Critical) Review of Current Medical Literature

ABSTRACT Introduction Anal sex is practiced by people of all sexualities, genders and bodies. Despite common practice, there is relatively little in the clinical literature about anal sex from a more sex-positive “sexual health” perspective. Objective To review the medical literature related to anal intercourse, with attention to the fraction that focuses on the sex positive aspects of anal sex to address and support the sex-based questions and concerns of adults who practice it. Methods A comprehensive literature review was conducted in accordance with PRISMA guidelines, using PubMed. For our search, we generated a comprehensive list of synonyms for anal intercourse and combined them with synonyms for sex positivity (sexual satisfaction, erogenous, pleasure, and orgasm). Results We identified a total of 149 articles from the search terms. Of these articles, 59 abstracts were relevant to include and were reviewed. Among these abstracts, 23 manuscripts were reviewed in full and only 20 of these were acceptable for inclusion in this review. Twelve of the twenty papers included in our review were primarily sexual health focused, while the other eight primarily pathology focused. Men who have sex with men (MSM) is the population most considered within the discussion of anal sex. There was a trend towards identifying the influence of external factors on the sexual outcomes of anal sex in MSM, such as condom use, lubricant use, prostate cancer, and drug use. Among women who have sex with men (WSM), 28.4% described the first experience as pleasant and 62.3% continued to practice anal sex. However, almost half of WSM found their first experience to be too painful to continue. Women who have sex with women (WSW) were missing from the discussion of anal sex and sexual health. Conclusions Though the medical literature contains an abundance of studies of “sexual pleasure” and “sexual function” these are commonly hetero-normative and focus on penile-vaginal intercourse, and very rarely include anal stimulation/sex. Given that anal sex is widely practiced, the dearth of sex-positive literature focused on anal sex suggests both that patient's practices of anal sex is less commonly queried by providers, and, that there is a need for medical literature to help inform providers and patients about how to make anal sex safer and more satisfactory. Second to the general U.S. population, other small but important subgroups for whom this is relevant include cancer survivors working to recover their sexual health, and transgender women awaiting gender affirming genital surgery. There is a need for more investigation into the sex positive nature of anal sex. Disclosure No

Sexual Function in Women With Differences of Sex Development or Premature Loss of Gonadal Function

Previous studies have suggested that sexual function may be compromised in women born with differences of sex development (DSD) or early loss of gonadal function. To describe sexual function and sexual wellbeing in women with complete androgen insensitivity syndrome (CAIS), complete gonadal dysgenesis (GD) and premature ovarian insufficiency (POI) in relation to gynecological measures and in comparison with unaffected women. A cross sectional study including 20 women with CAIS, 8 women with 46,XY GD, 8 women with 46,XX GD, 21 women with POI, and 62 population-derived controls. Study participants underwent gynecological examination for anatomical measurements and evaluation of tactile sensitivity. They responded to the validated Sexual Activity Log (SAL), Profile of Female Sexual Function (PFSF), and the Personal Distress Scale (PDS). The women with CAIS, XY GD, XX GD and POI showed overall satisfying sexual function in comparison to unaffected age-matched population female controls with a median of 1 to 2 satisfying sexual episodes per week among both the patients and the controls depending on available partner. Women with CAIS had shorter vagina and smaller clitoris and women with XY GD had a significantly shallower vagina in comparison to controls. Clitoral width was also significantly smaller among women with XX GD compared to controls. However, results showed overall good genital touch sensitivity with no significant differences between groups. Women with DSD or POI can be informed on overall satisfactory sexual function and normal genital touch sensitivity. The strength is the use of age-matched population-based controls to these rare conditions of DSD and POI. Limitations are the nonresponder rate of recruited controls, as well as the small groups of women with DSD. Women with differences of sex development or early loss of gonadal function show overall good sexual well-being, however clinicians have to make efforts to optimize caretaking and treatment to ensure good sexual quality of life for all patients.

An Alternative Option for Gender-affirming Revision Vaginoplasty: The Tubularized Urachus-peritoneal Hinge Flap

INTRODUCTION: Peritoneal vaginoplasty has been reported for congenital and primary gender-affirming cases, but few have reported its use to treat postoperative neovaginal shortening after penile-inversion vaginoplasty. Recent adaptations of peritoneal vaginoplasty are modifications of the Davydov procedure, wherein peritoneum of the bladder, rectum, and Pouch of Douglas are incorporated to lengthen the vaginal canal. Here we describe our alternative technique using a single urachus-peritoneal hinge flap and discuss its proposed advantages. METHODS: We performed retrospective review of all trans-women with post-penile-inversion vaginoplasty vaginal canal shortening who underwent revision surgery with our technique. All cases were performed via combined trans-perineal and robotic-laparoscopic approaches. Preoperative and postoperative neovaginal circumference and depth were recorded. With a dilator in the canal, the peritoneum and terminal canal-end were incised and spatulated. The anterior canal-remnant epithelial edge was sutured to the anterior peritoneal edge. A midline, inferiorly based peritoneal flap (min.12-cm width) was elevated craniocaudally from the umbilicus to the mid-posterior bladder. The flap’s free end was flipped posteriorly and sutured to the posterior edge of the open canal remnant, to create a peritoneum-lined pouch. The pouch’s lateral edges were sutured together. We confirmed water-tight closure. Patients resumed dilation on POD 8 and douching on POD 10. RESULTS: Five patients underwent peritoneal vaginoplasty with our technique from 5/2019 to 8/2020. Mean age was 32 years. Preoperative: mean canal girth was >12 cm, and depth was 8.6 (±1.8) cm. Immediate postoperative: mean girth was still >12 cm; depth was 16.8 (±1.2) cm (mean increase: 8.2 cm). At a mean follow-up of 1 year: mean girth was 11–12 cm, and depth was 13.5 (±1.8) cm (mean increase: 4.9 cm). There were no immediate complications. One patient developed anastomotic stenosis at 6 weeks postoperative, managed conservatively with dilation under anesthesia. All five patients endorse satisfactory sexual function; 3 of 5 report vaginal receptive intercourse. CONCLUSIONS: Early results suggest that our peritoneal vaginoplasty technique is a safe and effective option to treat neovaginal shortening. Advantages over existing techniques include: (1) No resting tension on peritoneal sutures, (2) Option for layered closure with omental interposition, and (3) Total exclusion of the rectum and Pouch of Douglas. Due to limited available peritoneum, we reserve this technique for cases where there is adequate residual canal girth and at least 6–7 cm of residual depth.

Erectile Dysfunction in Renal Transplant Patient - A Prospective Observational Study

Introduction: Erectile dysfunction (ED), defined as an inability to obtain or maintain an erection adequate for satisfactory sexual function, is present in up to 50–80% of patients with chronic kidney disease (CKD) (1). The rate of erectile dysfunction (ED) in patients with chronic kidney disease (CKD) was shown to be 75%, whereas it decreased to 59% in kidney transplantation recipients (KTRs). Materials and Methods: A 264 Renal Transplant Patient is included in this study. Both male and female patient included in this study. The International Index of Erectile Function questionnaire – 5 (IIEF-5) (SHIM) Scoring systems is used. Results: Total 264 patients are included in the study.34 patients not responded. According to SHIM score 4 patients have sever erectile dysfunction, 21 patient have moderate erectile dysfunction, 78 patients have mild to moderate erectile dysfunction, 104 patients have mild erectile dysfunction and 23 patients have no erectile dysfunction. After 1 year of renal transplant, according to SHIM score 3 patients have sever erectile dysfunction,14 patient have moderate erectile dysfunction, 47 patients have mild to moderate erectile dysfunction, 67 patients have mild erectile dysfunction and 99 patients have no erectile dysfunction. Conclusion: IIEF-5 is an effective means to establish and diagnose the erectile dysfunction. Advance age, prolonged dialysis, diabetes mellitus and smoking were important risk factors for erectile dysfunction. The incidence of ED in patients with ERSD and KTRs is quite high, and its management is particularly difficult due to many interfering factors.

V07-02 AN ALTERNATIVE OPTION FOR GENDER-AFFIRMING REVISION VAGINOPLASTY: THE TUBULARIZED URACHUS-PERITONEAL HINGE FLAP

You have accessJournal of UrologySexual Dysfunction & Transgender (V07)1 Sep 2021V07-02 AN ALTERNATIVE OPTION FOR GENDER-AFFIRMING REVISION VAGINOPLASTY: THE TUBULARIZED URACHUS-PERITONEAL HINGE FLAP Nance Yuan, Amit Gupta, and Maurice Garcia Nance YuanNance Yuan More articles by this author , Amit GuptaAmit Gupta More articles by this author , and Maurice GarciaMaurice Garcia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002034.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Peritoneal vaginoplasty has been reported for congenital and primary gender-affirming cases, but few have reported its use to treat post-op neovaginal shortening after penile-inversion vaginoplasty (PIV). Recent adaptations of peritoneal vaginoplasty are modifications of the Davydov procedure, wherein peri-rectal/peri-vesical peritoneum are incorporated to lengthen the vaginal canal. Here we describe our alternative technique using a single urachus-peritoneal hinge flap and discuss proposed advantages. METHODS: We performed retrospective review of all trans-women with post-PIV vaginal canal shortening who underwent revision surgery with our technique. All cases were performed via combined trans-perineal and robotic-laparoscopic approaches. Pre-op and post-op neovaginal circumference and depth were recorded. With a dilator in the canal, the peritoneum and terminal canal-end were incised and spatulated. The anterior canal-remnant epithelial edge was sutured to the anterior peritoneal edge. A midline, inferiorly based peritoneal flap (min. 12-cm width) was elevated craniocaudally from the umbilicus to the mid-posterior bladder. The flap’s free end was flipped posteriorly and sutured to the posterior edge of the open canal remnant, to create a peritoneum-lined pouch. The pouch’s lateral edges were sutured together. We confirmed water-tight closure. Patients resumed dilation on POD 8 and douching on POD 10. RESULTS: Five patients underwent peritoneal vaginoplasty with our technique from 5/2019 to 8/2020. Mean age was 32. Pre-op: mean canal girth was >12 cm, and depth was 8.6 (±1.8) cm. Immediate post-op: mean girth was still >12 cm; depth was 16.8 (±1.2) cm (mean increase: 8.2 cm). At mean follow-up of 1 year: mean girth was 11-12 cm, and depth was 13.5 (±1.8) cm (mean increase: 4.9 cm). There were no immediate complications. One patient developed anastomotic stenosis at 6 weeks post-op, managed conservatively with dilation under anesthesia. All 5 patients endorse satisfactory sexual function; 3/5 report vaginal receptive intercourse. CONCLUSIONS: Early results suggest that our peritoneal vaginoplasty technique is a safe and effective option to treat neovaginal shortening. Advantages over existing techniques include: 1. No intra-op or post-op resting tension on peritoneal sutures, 2. Option for layered closure with omental interposition, and 3. Total exclusion of the rectum. Due to limited available peritoneum, we reserve this technique for cases where there is adequate residual canal girth and at least 6-7 cm of residual depth. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e551-e551 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nance Yuan More articles by this author Amit Gupta More articles by this author Maurice Garcia More articles by this author Expand All Advertisement Loading ...

Sexuality of Female Spina Bifida Patients: Predictors of a Satisfactory Sexual Function.

To assess the sexual function of women with spina bifida (SB), and to verify the factors that influence their sexual function. A cross-sectional study in which a validated female-specific questionnaire was applied to 140 SB female patients from four different cities (Porto Alegre, Brazil; and Barcelona, Madrid, and Málaga, Spain) between 2019 and 2020. The questionnaires collected data on the clinical characteristics of SB, and female sexual function was assessed using the 6-item version of the Female Sexual Function Index (FSFI-6) validated to Portuguese and Spanish. Half of the patients had had sexual activity at least once in the life, but most (57.1%) did not use any contraception method. Sexual dysfunction was present in most (84.3%) patients, and all sexual function domains were impaired compared those of non-neurogenic women. The presence of urinary and fecal incontinence significantly affected the quality of their sexual activity based on the FSFI-6. The specific clinical aspects of the SB patients, such as urinary and fecal incontinence, should be properly addressed by their doctors, since they are associated with reduced sexual activity and lower FSFI-6 scores in the overall or specific domains. There is also a need to improve gynecological care among sexually-active SB patients, since most do not use any contraceptive methods and are at risk of inadvertent pregnancy.

Functional and Patient Reported Outcomes Following Total Glans Resurfacing

Whilst there is a trend away from aggressive nonorgan sparing surgical treatments for malignant penile disease, a variety of penile preservation options exist but functional outcomes and patient reported outcomes (PROs) in this area are poorly reported to date. The aim of this study is to report functional outcomes and PROs of total glans resurfacing (TGR) in a consecutive series of patients with lichen sclerosis (LS) or localized penile cancer (PC). From 2004 to 2018 a consecutive series of patients underwent TGR for the management of LS or localized PC in a tertiary referral network. Patient clinical records and operative notes were retrospectively reviewed. Statistical analysis was conducted with Stata 12. Urinary and sexual outcomes were recorded utilizing both the International Index of Erectile Function (IIEF) and International Prostate Symptom Score (IPSS) validated questionnaires while PROs were extrapolated from a 5-item "ad hoc" telephone questionnaire administered at 1 year post procedure. 37 consecutive patients were enrolled. Histology results demonstrated LS in 16 patients, with the remaining 21 having a diagnosis of PC. The most common reasons for patient presentation were local pain (32.4%), pruritus (37.8%) and bleeding (29.7%). Median follow-up was 22 (IQR 13-77) months. Median age was 62 (IQR 55-68).Neither of the questionnaires assessing urinary and sexual function showed any significant deterioration after surgery. Glans sensitivity was fully maintained in 89.2% of cases. 94.5% of patients reported to be fully satisfied with the aesthetic appearance of the penis and would consider undergoing the same procedure again if necessary. 91.9% of patients would recommend the same procedure to someone else. An overall improvement of the quality of life was reported by 86.4% of patients. TGR should be considered a treatment of choice for selected cases of benign or malignant penile lesions. Our study has some limitations, the first being its retrospective nature. Furthermore, despite being one of the largest series to date, follow-up duration is somewhat limited and a control group is lacking. TGR represents an excellent surgical option ensuring satisfactory voiding and sexual function, as well as cosmesis for selected cases of penile lesions.

The interaction between inflammation, urinary symptoms and erectile dysfunction in early‐stage prostate cancer treated with brachytherapy

Erectile function has been shown to decline as a function of increasing peripheral blood inflammatory markers, namely the neutrophil-to-lymphocyte ratio (NLR). We evaluated if the association between NLR and erectile dysfunction (ED) applies to patients with localised prostate cancer. We included 1,282 patients who underwent brachytherapy. ED was classified before treatment according to the Terminology Criteria for Adverse Event Scale version 3.0. ED was defined as the need for the use of oral pharmacologic or mechanical assistance to have satisfactory sexual function. We found that patients with ED were older (p<.001), more likely to have hypertension (p=.002), statin use (p=.002), diabetes (p<.001) or an IPSS≥8 (p<.001). On univariable logistic regression analysis, an NLR of ≥3 was statistically significantly associated with ED (OR 1.32, p=.029). But on multivariable analysis, the association between elevated NLR and ED was not statistically significant (p=.17). Significant were age (OR 1.12, p<.001), IPSS≥8 (OR 1.50, p=.008), the presence of hypertension, hyperlipidemia and diabetes (OR 2.27, p<.001), and prostate volume (OR 0.99, p=.041). The NLR does appear to be a surrogate marker of chronic inflammation that causes baseline ED in patients with localised prostate cancer.

AVALIAÇÃO DA FUNÇÃO SEXUAL DE MULHERES NA MENOPAUSA

The climacteric can present hormonal, physiological and metabolic variation, along with psychosocial changes, that have repercussions on life and sexual interest. The objective was to assess and classify the sexual function of women in menopause. It was recruited 84 women for the research, of which 57 come within inclusion criteria: experiencing menopause (cessation of menstrual cycles for at least 12months) and having had an active sexual life in the last six months. The Female Sexual Quotient (FSQ) domains were evaluated: desire and sexual interest,foreplay,arousing of the woman and sexual interaction with partner,comfort in sexual intercourse,orgasm and sexual satisfaction. The total score for FSQ determined the performance/sexual satisfaction pattern and, of the 57 women, the major proportionwas from regular to good (43.86%), while null to bad (7.01%) had lowest proportion. The total FSQ score, it was possible to verify that 71.93% of the participants presented an adequate score, having scored ≥62 points. It was concluded that the evaluated women presented adequate and satisfactory sexual function.

Effect of surgical repair of acquired buried penis on sexual function in adults.

This study was performed to investigate the effect of surgical repair of acquired buried penis on sexual function in adults and provide a reference for clinical treatment. Thirty-two adult patients who underwent surgical treatment of buried penis from August 2010 to August 2017 were selected as the study group. The basic operative method was penile lengthening. Suprapubic liposuction, suspensory ligament release, and preputial plasty were performed according to the clinical manifestations. The changes in erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction sexual function were evaluated according to the International Index of Erectile Function (IIEF) before and after treatment. All 32 patients were analyzed by the IIEF before and after the operation. The results showed statistically significant differences in sexual function before and after the operation (P < 0.05). Surgical repair of acquired buried penis in adults can significantly improve patients' sexual function.

Free Tissue Transfer Penile Reconstruction.

Phalloplasty can be a challenging plastic surgery procedure associated with complications and unsatisfactory results. Phalloplasty has become an important procedure in the setting of trauma, partial or complete excision of the penis, and gender affirmation. Advances in microsurgery has expanded penile reconstruction through free tissue transfer techniques which include the radial forearm free flap, fibular osteocutaneous flap, anterolateral thigh flap, latissimus dorsi flap, scapular flap, and abdominal flaps. Each procedure has advantages and disadvantages; most of the procedures achieve adequate cosmetic results with high patient satisfaction. Most of the surgical complications are related to the reconstruction of the urethra or creating rigidity for intercourse. The main goals of reconstruction are to create a cosmetically appealing phallus with satisfactory sexual function.

Treatment of the Mayer–Rokitansky–Küster–Hauser syndrome with autologous in vitro cultured vaginal tissue: descriptive study of long‐term results and patient outcomes

Evaluating sexual function and quality of life (QoL) in patients treated with a modified Abbé-McIndoe technique using invitro cultured autologous vaginal mucosa. Descriptive study. Policlinico Umberto I, Sapienza University of Rome. From 2006 to 2016, 39 women affected by Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) underwent vaginoplasty at our centre using a modified Abbé-McIndoe technique with invitro cultured autologous vaginal tissue. For each patient, vaginal tissue was obtained by full-thickness biopsy of the vaginal vestibule. Following enzymatic dissociation, cells were cultured for 2-3weeks before the transplant. Each patient completed two validated questionnaires to quantify sexual function and QoL: the Female Sexual Function Index (FSFI), administered at 12, 36, and 60months, and the Psychological General Well Being Index (PGWBI) administered at 0, 6, and 36months after surgery. Twelve months after surgery, 29 patients were engaging in regular sexual activity. The FSFI test results showed a satisfactory sexual function compared to the general population, with median values of 25.85 (range 4.6-30.5) at 12 months, 27.2 (range 4.4-33.6) at 36 months, and 29.6 (range 23.9-33.6) at 60 months. The PGWBI questionnaire showed a median score of 420.5 (range 108-540) before surgery, and 459 (range 252-533) at the 60-month follow-up. Vaginoplasty performed with the use of autologous vaginal tissue, besides ensuring a long-term satisfying sex life, helps in achieving an improvement in QoL that is maintained over time. Vaginoplasty using invitro vaginal tissue ensures a satisfactory sexual function and improves quality of life.