Sexual Function Research Articles

INNOVATIVE ASPECTS OF OPEN INGUINAL HERNIA SURGERY: REDUCING COMPLICATIONS AND PREVENTING RECURRENCES

Inguinal hernias constitute a significant portion of surgical pathology and remain among the most common reasons for seeking surgical consultation. According to the World Health Organization, inguinal hernias occur in 4-5% of the adult population, with men being affected 7 to 10 times more frequently than women. The aim of the study. The present study is aimed at improving the effectiveness of treatment, reducing the frequency of relapses and complications, as well as improving long-term treatment outcomes. Research materials and methods. This study is based on the diagnostic and treatment outcomes of patients with inguinal hernias who underwent surgical intervention at the surgical department of the multidisciplinary regional hospital in Samarkand between 2019 and 2024. A total of 196 male patients with various types of inguinal hernias were selected for retrospective and prospective analysis. The results of the study. The study identified key risk factors for inguinal hernias, including hard physical work, increased intra-abdominal pressure and connective tissue dysplasia. The factor analysis of the causes of relapse and unsatisfactory results in patients in the comparison group, such as impaired sexual function and testicular atrophy on the operated side, showed positive long-term effect in patients in the main group. Among 79.6% of patients followed in the long-term period, no recurrence of the disease was observed. None of the patients reported a sensation of a foreign body in the operative area, although some patients of reproductive age reported sexual dysfunction. Quality-of-life assessment indicated that implementation of a differentiated algorithm for treatment strategy selection increased the proportion of “excellent” and “good” outcomes from 88.3% to 100.0%. Conclusion. The developed algorithm for selecting the method of inguinal canal plastic surgery, and the improvement of surgical instruments has significantly reduced the incidence of early postoperative complications. The use of a modified preperitoneal alloplasty technique demonstrated excellent long-term results, decreasing recurrence rates and improving patients’ quality of life.

Comprehensive assessment of sexual function in male survivors of childhood cancer: A report from the Childhood Cancer Survivor Study.

Assessment of sexual dysfunction among adult male survivors of childhood cancer has primarily been limited to erectile dysfunction. This study aimed to characterize sexual functioning more comprehensively among a large population of male survivors of childhood cancer. Male survivors (N=1595, 22.0-59.4 years, median age, 37.8 years) and siblings (N=269, 21.5-60.8 years, median age, 38.9 years) from the Childhood Cancer Survivor Study completed the Sexual Functioning Questionnaire (SFQ) to assess interest, desire, arousal, satisfaction, activity, orgasm, masturbation, relationship, and problems. Poor sexual functioning was defined as SFQ Total scores >2 standard deviations below siblings' mean. Multivariable logistic regression identified risk factors for poor sexual function. Survivors (8.3%) were more likely to report poor sexual functioning as compared to siblings (4.9%, odds ratio [OR], 1.9; 95% confidence interval [CI], 1.1-3.4) and reported lower SFQ total scores (p<.001) and lower means on seven subscales. Poor sexual functioning among survivors was associated with older age (40-49 years: OR, 3.81; 95% CI, 1.78-8.18; 50-59 years: OR, 6.45; 95% CI, 2.28-18.30), not being married (OR,4.39; 95% CI, 2.66-7.26), lower education (OR, 3.07; 95% CI, 1.32-7.14), learning/memory problems (OR,1.83; 95% CI, 1.02-3.27), and high-dose cranial (≥40 Gy: OR, 3.45; 95% CI, 1.58-7.51) or high-dose testicular (≥10 Gy: OR,4.16; 95% CI, 1.66-10.39) radiation. Adult male survivors report poor sexual functioning at twice the rate expected before age 60 years. High-dose cranial or testicular radiation, as well as social and cognitive factors, contributes to risk. Improved awareness of sexual dysfunction prevalence and risk factors in male childhood cancer survivors can help clinicians better assess and treat those at highest risk.

Sexual function in immune-mediated inflammatory diseases: A biopsychosocial systematic review.

This systematic review evaluates the impact of immune-mediated inflammatory diseases (IMIDs) on sexual function and health-related quality of life (HR-QoL) in both men and women, from a biopsychosocial perspective. Diseases assessed include rheumatoid arthritis, psoriatic arthritis, psoriasis, ankylosing spondylitis, Crohn's disease, and ulcerative colitis. A total of 42 studies were included following a systematic search in PubMed/MEDLINE. The review adhered to PRISMA guidelines and was registered in PROSPERO (CRD42024518043). Results highlight a high prevalence of sexual dysfunction in IMID patients, significantly impairing quality of life. Assessments were primarily conducted using the Female Sexual Function Index (FSFI) and the International Index of Erectile Function (IIEF). Women, particularly those with rheumatoid arthritis and inflammatory bowel disease, exhibited higher vulnerability, with risk factors being disease severity, pain, depression, and anxiety. These findings underscore the necessity of a multidisciplinary and biopsychosocial approach involving rheumatologists, gastroenterologists, psychologists, and sexologists. Regular assessments and tailored interventions targeting sexual health are essential to optimize outcomes and to address this often overlooked dimension of patient care.

Sexual Quality of Life-Female (SQoL-F): Translation, cultural adaptation and validation of the Brazilian Portuguese version in postpartum women.

Sexuality plays an important role in quality of life, and the postpartum period may negatively affect women's sexual function. This study aimed to translate, culturally adapt, and validate the Sexual Quality of Life - Female (SQoL-F) for use for use in Brazilian women in the postpartum period. The original version of the SQoL-F was translated and back translated by four independent sworn translators. A sample of 125 women in the late postpartum phase participated in the cultural adaptation (n=30) and convergent validation (n=95) phases. For the latter, the instrument was compared with the Brazilian version of the Female Sexual Function Index (FSFI). To assess reproducibility, 25 of the 95 women who participated in the validation phase completed the SQoL-F twice, at different times (two interviewers administered the SQoL-F, 15 to 20 days apart). Cronbach's alpha was 0.905 (intraclass correlation=0.974; 95%CI: 0.943-0.988; p<0.001). Significant, moderate, positive correlations were observed between the SQoL-F score and the FSFI total score (r=0.572; p<0.001) and domains 'Desire' (r=0.502; p<0.001), 'Arousal' (r =0.576; p<0.001), and 'Satisfaction' (r=0.637; p<0.001). Excellent reproducibility was obtained for the SQoL-F score (intraclass correlation=0.974; 95%; CI: 0.943-0.988; p<0.001). The SQoL-F was adapted to the cultural context of Brazilian postpartum women, proved reproducible, and exhibited face, content, and construct validity.

Effect of a novel nutraceutical combination of EstroG-100 and γ-aminobutyric acid (GABA) in attenuating symptoms of menopause in healthy adult women: a randomized double-blinded placebo-controlled study

Objective: Menopause is associated with a range of symptoms, including hot flashes, mood swings, and others that adversely affect the quality of life of women. This study evaluated the effects of a novel nutraceutical combination containing γ-aminobutyric acid (GABA, 50 mg) and EstroG-100 (514 mg) on these symptom clusters using validated questionnaires. Methods: Eighty women were randomized into active (age: 53.28) or placebo (age: 52.94) groups. During week 1, participants were instructed to take the product whenever they began to experience vasomotor symptoms as pro re nata dosing (PRN dose, “as needed”). For the remainder of the study (weeks 2-5), participants were switched to a daily supplementation phase. Results: Hot flashes decreased in intensity (P = 0.001, starting day 1) and number (P = 0.002, starting day 2) in the active group compared with placebo. Stress response and anxiety also improved as early as day 1, with PRN dosing (P = 0.042). By day 3, there was significant reduction in stress, mood swings and headaches compared with the placebo group (P = 0.010, P = 0.024, and P = 0.008, respectively). In the daily supplementation phase from week 2 to week 5, improvements in vasomotor symptoms (day 7, P = 0.010), sleep quality (5 wk, P = 0.030), feelings of depression (3 wk, P = 0.028), tension (5 wk, P = 0.004), and sexual function (day 7, P = 0.029) were observed in those randomized to the active group compared with placebo. Conclusion: The novel nutraceutical combination of Estro-G100 and GABA may help support women during menopause.

Anorectal and urogenital functional outcome after robotic and transanal total mesorectal excision for rectal cancer: a propensity score-matched analysis.

Robotic-assisted total mesorectal excision (RaTME) and transanal TME (TaTME) are well-established approaches for rectal cancer with promising oncological outcomes. Concerns about postoperative defecatory, urinary, and sexual dysfunction have been raised and the impact on patients' quality of life remained uncertain. This study compared anorectal and urogenital functional outcomes after RaTME and TaTME. Patients with mid to low rectal cancer who underwent sphincter-saving surgery between January 2016 and December 2021 were reviewed. Questionnaires regarding low anterior resection syndrome (LARS), Wexner incontinence score, International Prostate Symptom Score (IPSS), and International Index of Erectile Function (IIEF-5) were administered at 1, 3, 6, and 12months after index operation without stoma or after stoma closure. Two hundred patients were included with 108 and 92 patients in the RaTME and TaTME group, respectively. After matching, 74 patients were analyzed in each group. LARS scores were significantly lower in the RaTME group than the TaTME group at 6months (27 [interquartile range (IQR) 13-36] vs 30 [IQR 24-39], p = 0.038) but similar at 12months (27 [IQR 13-33] vs 29 [IQR 13-36], p = 0.369) after stoma closure. Urinary function deteriorated after both operations but recovered at 6months after RaTME and 12months after TaTME. For sexual function, IIEF scores remained similar in the two groups. RaTME provided better anorectal function with lower LARS score at initial postoperative 6months but similar after 1year. Urinary function recovered earlier at 6months after RaTME while sexual function was comparable between two groups.

Sexual Well-Being After Bariatric Surgery Assessed with New Sexual Satisfaction Scale: A Case-Matched Study of Men and Women.

Severe obesity is associated with lower health-related quality of life, including sexual health. Metabolic and bariatric surgery (MBS) is well-known for its benefits in weight loss and the resolution of obesity-related comorbidities, but its impact on sexual satisfaction remains less documented. Obesity can negatively affect sexual health through hormonal imbalances, lowered self-esteem, and physical limitations.This study aims to evaluate differences in sexual satisfaction following MBS using validated sexual health assessment tools. This case-matched study involved patients awaiting MBS (preoperative group) and those at 1-year follow-up (postoperative group). Participants were matched by age and preoperative BMI. Sexual satisfaction was measured using the New Sexual Satisfaction Scale (NSSS), along with gender-specific tools: the Female Sexual Function Index (FSFI) and the International Index of Erectile Function (IIEF). Statistical analysis was performed using t-tests, Mann-Whitney tests, and χ2 tests. After matching, 190 pairs were analyzed based on gender. Postoperative patients reported a 24% higher NSSS score compared to preoperative patients (p < 0.001). Male participants showed significant improvements in all IIEF domains except orgasmic function, with the greatest improvement in erectile function. Female participants demonstrated a 20% higher FSFI score, with notable improvements in arousal and desire but not pain. There are significant differences in sexual satisfaction before and after MBS in both men and women. Future studies should focus on the long-term sustainability of these effects and the role of psychological support in enhancing sexual well-being post-surgery.

The effects of kidney transplantation on sex hormones, sperm parameters, and fertility rate in males: A systematic review.

End-stage renal disease (ESRD) is reported to be associated with the impairment of sex hormones, including decreased testosterone levels and increased follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin levels. Additionally, patients with ESRD often experience impaired spermatogenesis, leading to infertility. However, variations in study methodologies and reported outcomes make it challenging to draw definitive conclusions. Therefore, this study aims to evaluate the effects of kidney transplantation (KT) on these issues, which can be useful in counseling male patients with ESRD. A systematic search was conducted in Web of Science, Medline (via PubMed), and Embase (via Scopus) to identify peer-reviewed studies evaluating the impact of KT on sex hormones and reproductive parameters. A systematic review (SR) was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This review included English-language articles published between January 1975 and December 2024. Excluded from this search were reviews, editorials, book chapters, conference abstracts, case reports, and case series with up to four patients were excluded. A total of 2939 publications were initially identified, and 23 studies met the inclusion criteria, comprising 738 patients for analysis. Most studies reported a significant increase in testosterone levels 3, 6, and 12 months post-KT. LH and prolactin levels exhibited a trend parallel to that of testosterone. A statistically significant decrease in LH levels was observed at both 1 and 12 months post-KT, while prolactin levels showed a significant reduction at all evaluated time points from 1 to 12 months. In contrast, FSH levels fluctuated over time and did not demonstrate statistical significance at any assessment point. Additionally, KT led to improvements in testis biopsy findings, and all categories of sperm parameters. This SR demonstrates that KT improves sex hormone levels, sperm parameters, and sexual function in male kidney recipients. However, to gain a more comprehensive understanding of the sexual health of male kidney recipients, the establishment of an international database with prospectively collected data is warranted.

Clinical efficacy and safety of transurethral prostate blue laser vaporization versus green laser vaporization in the treatment of benign prostatic hyperplasia with different prostate volumes: A retrospective comparative study.

This study analyzes and compares the clinical efficacy and safety of transurethral blue laser vaporization of the prostate (BL-PVP) and transurethral green laser vaporization of the prostate (GL-PVP) in the treatment of benign prostatic hyperplasia (BPH). A retrospective analysis was conducted on the clinical data of 97 patients with BPH who were treated at the Urology and Nephrology Department of Xi'an People's Hospital (Fourth Hospital of Xi'an) from June 2022 to June 2024. Patients were divided into 2 groups based on the surgical technique: the BL-PVP group (n = 46), which underwent transurethral BL-PVP, and the GL-PVP group (n = 51), which underwent transurethral GL-PVP. Additionally, patients were further categorized based on prostate volume into group A (medium volume, 30-80 mL) and group B (large volume, >80 mL). Perioperative indices and postoperative follow-up data were compared between the 2 groups. Both the BL-PVP and GL-PVP groups demonstrated significant improvements in International Prostate Symptom Score, maximum flow rate, and postvoid residual at 1, 3, and 6 months postoperatively, with overall comparable efficacy between the 2 procedures (P < .05). The BL-PVP group showed a significant advantage in bladder irrigation time, catheter indwelling time, and length of hospital stay, particularly in patients with medium prostate volume (P < .05). Furthermore, the BL-PVP group exhibited faster recovery of urinary control in the early postoperative period, with lower residual urine volume and symptom scores at 1 and 3 months compared with the GL-PVP group. BL-PVP demonstrates an advantage in preserving sexual function in patients with medium-sized prostates (P < .05). BL-PVP is a safe and effective surgical approach for the treatment of BPH, offering comparable therapeutic outcomes to GL-PVP, with notable advantages in postoperative recovery speed and early improvement in urinary control. Due to its precise vaporization effect and minimal thermal injury, BL-PVP demonstrates certain functional advantages, particularly for patients with a high demand for fast recovery and sexual function preservation. This study indicates that BL-PVP is a promising innovative treatment with significant clinical application potential, providing important guidance for selecting surgical options for BPH patients.

Impaired Fertility and Sexual Function in Women With Hirschsprung Disease: Results From an International Multi-Centre Cross-Sectional Study.

Hirschsprung is a congenital disorder affecting the gastrointestinal tract. However, pelvic colorectal surgery in infancy has been hypothesised to impact gynaecological outcomes in later life. Describe sexual function and fertility outcomes in women with Hirschsprung disease compared to population controls. Assess factors associated with poor outcomes (sexual dysfunction and subfertility). International multicentre cross-sectional cohort study with comparison to controls from the general population. Status post-discharge from paediatric services. Female patients aged > 20 years. Validated questionnaire-based survey with linkage to patient medical records. Comparison with controls using univariate analyses. Sexual dysfunction (Female Sexual Function Index; FSFI ≤ 26), Subfertility at 1 and 2 years. Sexual dysfunction as per the FSFI was more common in patients and associated with poor functional outcomes; sexual abstinence seemed to associate even more so with poor bowel outcomes. Subfertility was higher in patients compared to controls (1 year: 21/45 (47%) vs. 38/178 (21%), p = 0.0008; 2 years: 12/45 (27%) vs. 17/178 (10%), p = 0.004). There was an increased proportion of patients who had accessed fertility services (20/45 (44%) vs. 43/178 (24%); p = 0.009), the proportion of successful pregnancies in patients attempting to conceive with IVF (11/17 (65%) vs. 27/43 (63%); p = 1.0) was similar. These novel data suggest that women with Hirschsprung disease who have undergone reconstructive surgery may be at risk for adverse sexual function and fertility outcomes.

Symptoms of pelvic floor dysfunctions during pregnancy and postpartum

BackgroundMonitoring Pelvic Floor Dysfunction (PFD) symptoms during pregnancy is crucial to treating and preventing the onset or worsening of dysfunctions in the postpartum period. This study aimed to evaluate PFD symptoms over time in pregnant and postpartum women.MethodologyThis longitudinal follow-up study involved pregnant and postpartum women. PFD symptoms were assessed using an obstetric history questionnaire and the Australian Pelvic Floor Questionnaire (APFQ). Pregnant women were grouped into two periods: up to 28 weeks (Period 1) and from 28 to 40 weeks of gestation (Period 2). Postpartum women were divided into three periods: up to 6 weeks (Period 3), between 7 and 24 weeks (Period 4), and more than 24 weeks postpartum (Period 5).ResultsA total of 46 and 44 pregnant women and 65, 53, and 39 postpartum women were analyzed in Periods 1 to 5, respectively. For pregnant women, non-parametric ANOVA revealed a significant difference (p = 0.02) in sexual function between Periods 1 (2.1 ± 2.8) and 2 (1.1 ± 1.8). Among postpartum women, urinary function improved significantly across Periods 3 (9.5 ± 5.9), 4 (4.0 ± 5.1), and 5 (5.7 ± 5.3; p < 0.001). Sexual function deteriorated significantly across these periods. Spearman’s correlation indicated moderate associations between urinary function and pregnancy (p < 0.001, r = 0.4) and between prolapse and parity (p = 0.02, r = 0.35) for pregnant women. For postpartum women, moderate correlations were observed between urinary function and parity (p = 0.02, r = 0.3), bowel function and age (p = 0.04, r=-0.29), and sexual function and age (p = 0.049, r=-0.3).ConclusionThe study highlights variations in PFD occurrence during pregnancy and the postpartum period, particularly concerning urinary and sexual function.

Sexual function in adolescence after childhood hypospadias repair: a patient-reported outcome study.

To present data on sexual function in post-pubertal patients after hypospadias surgery in childhood. We assessed 169 (96 distal, 20 midshaft, 53 proximal) patients with hypospadias born between 1991 and 2003, who underwent surgery before the age of 5 years. At a median (interquartile range) follow-up age of 16.2 (16.0-16.8) years, participants completed a pre-mailed sexual function questionnaire, including the Erection Hardness Score (EHS) during the last control visit. Dorsal Nesbit-like plication was used for curvature correction in 62 patients. Previously published normative data served as controls. All patients reported having erections; 73% achieved EHS 4 (completely hard and fully rigid). In patients with distal hypospadias, EHS 4 was reported in 68% of cases, 85% of midshaft and 79% of proximal cases. Among those with and without curvature correction by Nesbit-like plication, EHS 4 was reported in 72% and 74%, respectively. The proportion reporting EHS 4 exceeded that of published controls (P < 0.01). Penile straightness during erection was reported by 95% of patients overall, with no significant differences across hypospadias subtypes or curvature correction status. Only one patient reported pain during ejaculation; none reported pain during erection. Ejaculation was reported by 95% of participants. Adolescents who underwent early hypospadias repair reported favourable sexual function outcomes, including high rates of erectile rigidity and ejaculatory function. Neither hypospadias severity nor the need for curvature correction affected these outcomes. These findings support the long-term sexual well-being of patients undergoing surgery for hypospadias in childhood.

Robot-assisted vs. laparoscopic rectal cancer resection: a narrative review of oncological outcomes, functional results, and future perspectives

Robot-assisted rectal resection has increasingly gained acceptance as a minimally invasive surgical approach for rectal cancer, primarily due to its enhanced precision, dexterity, and superior visualization compared to traditional laparoscopic surgery. Accumulating evidence from randomized controlled trials, systematic reviews, and large-scale national registry analyses underscores its feasibility and safety, particularly in technically demanding scenarios such as male patients, obese individuals, and those with low rectal tumors. Robotic surgery demonstrates favorable short-term outcomes, including significantly lower conversion rates, reduced intraoperative blood loss, and accelerated postoperative recovery. Nonetheless, results regarding operative duration, postoperative complications, and cost-effectiveness remain heterogeneous. Additionally, robotic techniques may facilitate improved functional preservation, especially concerning urinary and sexual functions, attributed to superior visualization and precise nerve-sparing capabilities; however, these benefits require further rigorous validation. Continued advancements in robotic technology and growing surgical proficiency necessitate future large-scale, multicenter trials to definitively establish the long-term oncological and functional advantages. Emerging robotic platforms and technological innovations hold promise for reducing costs and enhancing accessibility. This narrative review critically examines current evidence, outlining the clinical benefits, inherent limitations, and prospective advancements in robotic-assisted surgery for rectal cancer.

Impact of Abdominoplasty with Diastasis Recti Correction on Female Sexual Function: A 1-Year Prospective Follow-Up Study.

Diastasis recti abdominis (DRA) is a condition commonly affecting women postpartum, often leading to functional impairments, negative body image, and reduced quality of life. While abdominoplasty with DRA correction is known to improve core stability and aesthetic outcomes, its potential impact on female sexual function remains underexplored. This prospective study investigates the effects of conventional abdominoplasty with DRA correction on female sexual function using the validated Female Sexual Function Index (FSFI) over a 1-year follow-up period. A total of 37 female patients with postpartum DRA (inter-rectus distance >4cm) who underwent conventional abdominoplasty were included. Sexual function was assessed preoperatively and 12months postoperatively using the FSFI, encompassing six domains: desire, arousal, lubrication, orgasm, satisfaction, and pain. Patient satisfaction with the procedure was evaluated using a 5-point Likert scale. Statistical analysis was performed to identify significant changes in FSFI scores and their correlation with patient satisfaction. Postoperative FSFI scores demonstrated a significant improvement in total score (mean increase: 7.1; p < 0.005) and in the domains of arousal, orgasm, and satisfaction. Improvements in desire, lubrication, and pain were observed but not statistically significant. Higher patient satisfaction correlated with greater FSFI score improvement, although this was not statistically conclusive due to the small sample size. Notably, menopausal patients exhibited significant enhancements in overall FSFI scores (mean increase: 7.0; p < 0.005). One dissatisfied patient reported a decline in FSFI, highlighting individual variability. Conventional abdominoplasty with DRA correction significantly improves sexual function in women, particularly in domains of arousal, orgasm, and satisfaction, while enhancing overall quality of life. These findings emphasize the importance of addressing functional and psychological aspects in surgical outcomes. Further research, including larger controlled studies and longer follow-up, is necessary to confirm these results and explore predictive factors for optimal outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Body image, sexual dysfunction and psychological distress in people with multiple sclerosis

Purpose This study examined the relationships between sexual functioning, body image and mood in people with multiple sclerosis (MS). Materials and methods 104 people with MS and 101 healthy controls (HCs) completed an online survey that assessed sexual functioning, body image, and psychological well-being variables. People with MS were compared to HCs across study variables. Body image and psychological well-being variables were used as predictor variables in regression analyses with sexual functioning variables as dependent variables. Results People with MS reported greater sexual dysfunction (SD). They also reported lower body appreciation, higher levels of body dissatisfaction, poorer interoception, higher levels of anxiety and depression, and poorer quality of life, each of which were associated with SD. Body image and mood variables, in addition to disability status and illness duration accounted for 48.6% of the variance in tertiary SD (R 2 = 0.485, F (7, 96) = 12.914, p < 0.001, adjusted R 2 = 0.447). Conclusions Findings highlight the importance of assessing the nature of SD so that appropriate interventions can be delivered given the repercussions it has for quality of life. Interventions such as CBT and mindfulness-based programmes, in addition to psychoeducation and rehabilitative practices such as yoga may be beneficial. Implications for rehabilitation People with multiple sclerosis were significantly more impacted by sexual dysfunction, reported significantly greater body dissatisfaction, significantly lower body appreciation, and poorer body awareness compared to healthy controls. This study highlights the importance of identifying the domain(s) of sexual dysfunction being experienced so that the intervention can be tailored to the needs of the person. Interventions that target body awareness and improve the mind-body connection may protect against sexual dysfunction.

Patient‐Reported Outcomes and Surgical Results of Hand‐Sewn Versus Stapled Anastomosis for Lower Rectal Cancer Located 4–5 cm From the Anal Verge: A Subanalysis of the Ultimate Study

ABSTRACTBackgroundPreserving anorectal function while achieving oncological success is crucial in the treatment of lower rectal cancer near the anal canal. Despite advancements in laparoscopic surgery that facilitate anal preservation, post‐operative anorectal dysfunction considerably affects quality of life. Both hand‐sewn and stapled anastomoses are suitable options for tumors located 4–5 cm from the anus. However, evidence comparing the functional outcomes and complications associated with both anastomosis methods is lacking.MethodsThis multicenter, single‐arm prospective study included patients with cT1‐T2/N0/M0 adenocarcinoma located 4–5 cm from the anal verge, scheduled for upfront laparoscopic surgery. Anorectal function, post‐operative complications, urinary and male sexual function, and oncological outcomes were assessed using the validated scores.ResultsA total of 135 patients were analyzed and divided into hand‐sewn (n = 65) and stapled (n = 70) groups. The patient characteristics were similar, except for the tumors in the hand‐sewn group located 1 mm closer to the anal verge. No significant differences were observed in the post‐operative complications. Anorectal function, measured using Wexner scores, worsened at 3 months postoperatively and gradually improved in both groups. At 3, 6, 12, 24, and 36 months, the stapled group consistently showed better Wexner scores than the hand‐sewn group. Urinary function, sexual function, and oncological outcomes were similar in both groups.ConclusionStapled anastomosis may provide better anorectal function with comparable safety and oncological outcomes to hand‐sewn anastomosis. Therefore, stapled anastomosis may be preferred for tumors located 4–5 cm from the anal verge to ensure oncological safety.Trial RegistrationThis study was registered in the UMIN Clinical Trials Registry System (UMIN 000011750)

New insights into the role of testosterone in improving glucose and lipid metabolism in adult males

Testosterone plays a crucial impact on male growth and development, sexual function, muscle mass, and mental health. In recent years, the role of testosterone in regulating energy metabolism via multiple targets has increasingly drawn attention. It can not only enhance insulin sensitivity but also promote lipolysis, thus offering novel insights into the prevention and treatment of diabetes mellitus, fatty liver, and obesity. Timely testosterone supplementation in adult male patients with type 2 diabetes mellitus and obesity may bring significant metabolic benefits.

Expert consensus on the treatment of aging related to growth hormone deficiency

The secretion of growth hormone progressively decreases with advancing age, and some of the elderly develop age-related growth hormone deficiency. Physiological concentration of growth hormone is crucial for the regulation of material metabolism and the maintenance of organ and systemic functions in adults. Clinically, adult growth hormone deficiency manifests as a complex constellation of symptoms including obesity, fatty liver, sarcopenia, osteoporosis, diminished sexual function, reduced physical performance, and depression, which are partially analogous to the clinical phenotypes of aging. For patients with clearly identified causes or those with age-related growth hormone deficiency, physiological doses of growth hormone supplementation therapy can significantly improve the aforementioned symptoms. Consequently, adult growth hormone deficiency is considered as one of the endocrine causes for certain aging symptoms. Currently, clinicians have insufficient awareness of this issue. Age-related growth hormone deficiency should logically be an integral part of adult growth hormone deficiency, yet it has not received sufficient clinical attention and emphasis. The Pubertal Development and Gonadal Disorders Committee from Chinese Aging Well Association and Society of Endocrinology and Metablic Disease, China National Health Association organized 34 domestic experts from fields including endocrinology, nutrition, geriatric medicine, and sports medicine. Based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system for clinical evidence levels, they formulated expert consensus and proposed coping strategies centered around key scientific issues related to growth hormone therapy for anti-aging, including the target population for treatment, treatment risks and benefits, and the duration of treatment courses. By integrating the evaluation opinions from the Delphi method, 16 recommendation statements aiming to standardize the application of growth hormone therapy on anti-aging were finally determined. And in response to various issues in the field of growth hormone anti-aging therapy, the future research directions have been proposed.

Breast Cancer Information Grand Round for Survivorship (BIG-S) prospective cohort

Abstract Existing evidence indicates that long-term effects of breast cancer treatment can significantly impact survivors’ ability to fulfill their personal, familial, and social roles. However, few studies comprehensively integrate patient-reported outcomes (PROs) and real-world healthcare utilization data, particularly in Asian populations. Thus, we established a prospective cohort, the Breast Cancer Information Grand Round for Survivorship (BIG-S), to address these gaps and introduce this resource. The prospective BIG-S cohort recruited patients newly diagnosed with breast cancer at Samsung Medical Center starting in November 2018. Clinical data, recurrence, and healthcare utilization were systematically collected from electronic medical records by trained researchers, and body composition was measured using multifrequency bioelectrical impedance analysis. PROs were assessed following recommendations from the International Consortium for Health Outcomes Measurement (ICHOM). These included health-related quality of life, physical, psychological, social, and cognitive functions, symptoms, healthy behaviors, financial difficulty, spiritual well-being, and cancer adaptation, using validated questionnaires. A total of 2,749 patients participated, with an average age of 49.7 years. The mean quality-of-life score at diagnosis was 55.6, indicating moderate general well-being, and improved gradually to 68.2 at four years post-diagnosis. At baseline, participants showed high physical, cognitive, and role functioning scores but had relatively lower emotional and social functioning scores. Over four years, emotional and social functioning improved, whereas cognitive and role functioning declined. Survivors initially reported low sexual functioning, sexual enjoyment, and future perspectives, all of which significantly decreased during follow-up. Fatigue and insomnia were persistent throughout the observation period. Healthcare utilization initially concentrated on plastic surgery and rehabilitation medicine and increasingly shifted towards gynecology, family medicine, and psychiatry after two years. The BIG-S cohort uniquely integrates clinical data, PROs, and healthcare utilization patterns, offering comprehensive insights into breast cancer survivorship trajectories. Findings from BIG-S are expected to guide targeted interventions and inform tailored survivorship care strategies, especially for Asian breast cancer survivors.

Sexual function, depression, and quality of life in patients with irritable bowel syndrome

BackgroundIrritable bowel syndrome (IBS) is a prevalent functional disorder of the gastrointestinal (GI) tract, often accompanied by depression and sexual dysfunction. Depression and IBS may share similar pathophysiological mechanisms, making it essential to understand them for effective treatment. This study aims to compare the state of sexual function, depression, and quality of life in IBS patients experiencing depression with that of healthy subjects.MethodsIn this cross-sectional study, three groups of 49 individuals each were included: patients with irritable bowel syndrome (IBS), patients with depression without symptoms of IBS, and healthy individuals attending university internal clinics in Hamedan city. All patients were sexually active. Quality of life was assessed using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire, depression severity was measured using the Beck Depression Inventory (BDI), female sexual function was evaluated using the Female Sexual Function Index (FSFI), and male sexual function was assessed using the Male Sexual Health Questionnaire (MSHQ). Data were analyzed using the Chi-square test and analysis of variance.ResultsThe study compared depression scores, quality of life, and sexual performance among three groups: irritable bowel syndrome (IBS) patients, patients with depression, and a control group. Results showed that depression scores were significantly higher in the IBS and depression groups compared to the control group. Quality of life scores did not significantly differ between IBS and depression groups but were lower in both compared to the control group. Sexual performance, both in men and women, differed significantly across all groups. The relationship between quality of life and depression in IBS patients was inverse (r=-0.71, P = 0.001), while depression negatively correlated with sexual performance in men (r=-0.550, P = 0.001). Conversely, higher quality of life and better sexual performance showed a positive relationship in men (r = 0.335, P < 0.001). Based on the findings of the current study, it could be said that depression is significantly higher in IBS patients and depression is not the only intervening factor in the low sexual quality of IBS patients. Other factors such as physiological symptoms, medication side effects, and psychological stressors also contribute to causing sexual dysfunction in these IBS patients.