Sexual function in males after radical cystectomy
Min, C1; Qiang, L2; Feifan, W1; Wei, H1; Hongshen, W1; Junjie, C1; Yan, Z1; Zhenghui, H1; Yu, C1; Rikao, Y1; Xiaodong, J1
1: The first hospital affiliated to Zhejiang University, China; 2: The Second Chengdu Hospital Affiliated to Chongqing Medical University, China
Objective: Sexual function remains a relatively unexplored field within urology, especially for males who have undergone radical cystectomy (RC). There have been conflicting opinions regarding the superiority of open、 laparoscopic and robotic surgery in preserving sexual function after RC. The aim of this study was to shed light on these areas.
Materials and Methods: The selective questionnaires or questions ( International Index of Erectile Function (IIEF5)，Intra-vaginal Ejaculation Latency Time（IELT）, premature ejaculation diagnostic tool (PEDT),Self-Rating Anxiety Scale(SAS), Self-Rating Depression Scale( SDS), Quality of Life(QOL) , et al） regarding sexual function were sent to 976 males who had undergone RC and were alive 1 year postsurgery. 475 completed questionnaires were returned and analysed.
Results: A total of 475 patients undergoing RC (open n =324，lap n = 102 and robotic n=47) were followed up and the median age of the patients was 60.5 years (range 36-81 years). In general, 65% reported being sexually active before surgery, 17% 0.5 year post-surgery, 23% 1 year post-surgery, 31% 3 year post-surgery and 17% year post-surgery. Sexual function was decreased after RC and no significant difference was found among different ways of urinary diversions. Sexually active patients perceived a higher state of general health (SAS, SDS and QOL, P < 0.05). The median IIEF5 score was 3.8(range 0-18), 6.2(range 0-24)，7.8(range 0-25) and 4.6(range 0-25) for 0.5year，1year，3 years and 5years after surgery. The highest score was seen in the category of satisfaction, which reflected closeness with partner, sexual relationship and overall sex life. 32% were afraid to inflict harm on their partner by sexual contact and 17% were refused by their partners. Postoperative sexual function (almost all the questionnaires ) showed superiority in laparoscopic and robotic surgery compared with open surgery, with no difference between the two minimal invasive groups.
Conclusions: The available data are limited, but suggest that minimally invasive forms of surgical approach，both laparoscopy and robotic surgery ，demonstrate superiority in preservation of sexual function. However, many reported being satisfied overall although they had poor scores. Thus, the physician's main goal might be to give more information and guidance before and after surgery.
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