Journal Article

Sexual dysfunction after cystectomy and urinary diversion

Gilbert, Scott M., Mulhall, John P., Modh, Rishi A.

2014

Overview

Key Points Sexual dysfunction is a common, but often overlooked, consequence of radical cystectomy in both men and women Sexual dysfunction after radical cystectomy results from a combination of iatrogenic, organic, and psychological factors Health-related quality-of-life surveys specific to patients with bladder cancer have been developed in attempts to better understand the sources of sexual dysfunction Treatment protocols must be tailored to the specific source of sexual dysfunction in each patient and often require both medical treatments and counselling Surgical strategies such as nerve-sparing and vagina-sparing cystectomy might offer improved sexual outcomes while maintaining effective oncological control Cystectomy with urinary diversion is a key approach to the management of bladder cancer. This Review provides an overview of a complication that is common among the men and women who undergo such surgical treatment: sexual dysfunction. In particular, the tools that can be used to assess sexual function in this context and its effect on quality of life, the various contributory aetiological factors underlying sexual dysfunction, as well as approaches to treating sexual issues are discussed. Erectile dysfunction (ED) in men and sexual dysfunction in men and women are common after cystectomy and urinary diversion. Research has focused on both qualifying the prevalence of ED following cystectomy and identifying surgical approaches to limit sexual dysfunction after surgery, but most studies have been limited by small patient populations, an absence of control groups, and a lack of adjustment for confounding factors. Similarly, quality of life (QoL) research studies have also emerged in the context of bladder cancer and cystectomy, and increase our understanding of sexual outcomes associated with cystectomy. A number of instruments for collection of patient-reported outcomes among patients with bladder cancer treated with cystectomy are available for the assessment of condition-specific and procedure-specific QoL. However, other factors that negatively affect sexual function after removal of the bladder, such as psychological issues, age, and health-related competing risks for ED, body image, partner response, and change in life course and sexual priorities, have received less attention. Nevertheless, ED and sexual dysfunction are important complications of cystectomy and urinary diversion. Although changes in the approach to surgery, such as nerve-sparing cystectomy, might improve outcomes, evaluation and management of the source factors of ED and sexual dysfunction are necessary to optimize recovery of function.

• Publisher: Nature Publishing Group UK,Nature Publishing Group
• Subject: 692/699/2768/1575 / 692/699/2768/515 / 692/699/67/589/1336 / 692/700/565/545 / 692/700/784 / Bladder cancer / Body image / Cancer therapies / Care and treatment / Complications and side effects / Cystectomy / Cystectomy - methods / Erectile dysfunction / Erectile Dysfunction - etiology / Erectile Dysfunction - prevention & control / Erectile Dysfunction - therapy / Female / Humans / Iatrogenesis / Impotence / Male / Medicine & Public Health / Methods / Ostomy / Outcome Assessment (Health Care) / Patients / Postoperative Complications - etiology / Postoperative Complications - prevention & control / Postoperative Complications - therapy / Quality of Life / Questionnaires / Recovery of function / review-article / Reviews / Self image / Sexual disorders / Sexual Dysfunction, Physiological - etiology / Sexual Dysfunction, Physiological - prevention & control / Sexual Dysfunction, Physiological - therapy / Sexual Dysfunctions, Psychological - etiology / Sexual Dysfunctions, Psychological - prevention & control / Sexual Dysfunctions, Psychological - therapy / Urinary Diversion / Urological surgery / Urology / Vagina / Womens health