Evaluation of sexual dysfunction after radical cystectomy for muscle invasive bladder cancer in male patients and their spouses with orthotopic ileal neobladder or ileal conduit
Haque, ME1; Rahman, M2; Kaisar, I3; Salam, MA4
1: Enam Medical College and Hospital, Bangladesh; 2: Mymensingh Medical College and Hospital; 3: Urology and Transplantation foundation of Bangladesh ; 4: Urology and Transplantation foundation of Bangladesh
Objectives: Muscle invasive bladder cancer is one of the most important diseases in terms of morbidity and mortality. Although many modalities of treatment are required to manage the disease, radical cystectomy is the gold standard approach to offer the patient a cure. The morbidities associated with this surgical therapy are quite significant. After radical cystectomy two types of diversion are most popular, one is incontinent type ileal conduit and another one is continent orthotopic ileal neobladder. Both forms are associated with morbidities and complications. Sexual dysfunctions are also associated with both forms of diversion. We evaluated our experience of sexual function and dysfunction in male patients and their spouses requiring these forms of surgical therapies.
Material and Methods: During the period of January 2005 to Dec. 2015, male patients underwent radical cystectomy for muscle-invasive bladder carcinoma were evaluated. Patients with ileal conduit or Orthotopic ileal neobladder were selected for study. Patients who had no spouse or patients or spouses unwilling to participate were excluded from the study. An author constructed questionnaire was supplied to all patients attending outpatient department for follow-up and requested to fill all fields of the questionnaire with their spouses separately. For the convenience of the patients and their spouses a short modified questionnaire was made according to SHIM sexual health questionnaire, FACT-BL questionnaire and the Hospital Anxiety and Depression Scale (HADS). The main objective of the questionnaire was to evaluate the psychological and sexual status of both the patients and their spouses.
Results: Total 37 cases in orthotopic neobladder group and 82 patients in ileal conduit group were selected for the study. No significant differences were observed in demographic and clinical parameters in both groups. In questions addressing the psychosocial status and sexual life of patients, more favorable outcomes were observed in orthotopic neobladder group. Erectile dysfunction did not significantly different in two groups (p>0.5). Overall satisfaction was significantly high in patients with orthotopic neobladder. Psychosocial and sexual life were found significantly different in spouses of two groups (p<0.5). Ileal conduit was found unacceptable in all spouses but 85% spouses found happy with orthotopic neobladder group. Depression, anxiety and tension were significantly high in spouses of ileal conduit group. Overall satisfaction in patients and their spouses were also found significantly high in Orthotopic neobladder group (p<0.5)
Conclusions: Orthgotopic neobladder after radical cystectomy offers better sexual life than ileal conduit in patients and their spouses. Ileal conduit is not acceptable for the spouses.
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