A questionnaire study of sexological problems following urinary diversion in the female patient

Neobladder "Function": Tips and Tricks for Surgery and Postoperative Management

Orthotopic neobladder (ONB) reconstruction is a continent urinary diversion procedure increasingly used in patients with muscle-invasive bladder cancer following radical cystectomy (RC). It represents a valid alternative to the ileal duct in suitable patients who do not prefer a stoma and are motivated to undergo adequate training of the neobladder. Careful patient selection, taking into account the absolute and relative contraindications for ONB as well as an adequate recovery protocol after surgery are integral to the success of this procedure and the oncological and functional outcomes. The objective of this review is to summarize the current data on RC with ONB in terms of patient selection, preoperative preparation, surgical techniques and functional (continence and sexual activity) and oncological outcomes, with particular attention to the management of complications and the impact on quality of life (QoL).

Female Sexual Function and Body Image After Urinary Diversion for Benign Conditions

BACKGROUND

Simple cystectomy with urinary diversion is the favored option for treating conditions responsible of neurogenic bladder dysfunction after failure of conservative treatments. Despite the existence of validated assessment tools, the impact of cystectomy on female sexual function remains scarcely investigated.

AIM

The aim was to assess the sexual function and body image of female patients who underwent urinary diversion for a nonmalignant condition and to investigate the factors that may influence sexual life quality.

METHODS

36 female patients who underwent urinary diversion ± cystectomy for a benign condition between January 1, 2007 and December 15, 2019 were included. Standardized questionnaires were sent by mail between February and April 2021. Additional data were collected from patient computerized medical records.

OUTCOMES

The Female Sexual Function Index (FSFI), Body Image Scale (BIS), and Stoma Quality Of life (StomaQOL) questionnaires were used to assess sexual activity, body image, and quality of life related to a noncontinent stoma, respectively. The quality of pre- and postoperative information was also assessed.

RESULTS

The most frequent etiology of bladder dysfunction was multiple sclerosis (14, 38.9%). After surgery, 29 (80.6%) patients were sexually active and the mean (range) overall FSFI score was 15.2 (2-33.3). The mean (range) overall FSFI score and FSFI Arousal sub-score were lower for the 14 patients with an ileal conduit [11.1(2-33.3] and 1 (0-4.5)) compared to the 14 patients with a continent stoma or a native urethra [19.2 (2-29.3]; P = .04 and 3.15(0-5.4); P = .014). Regarding sexual counseling, 27 (79.4%) patients did not receive any information before surgery about possible consequences on their sexual activity, 31 (91.2%) were not asked about their sexual activity during follow-up. The mean BIS score was higher for patients with an ileal conduit (14.8) compared to patients with a continent stoma (9.7) or a native urethra (5.1; P = .002). Patients with an ileal conduit had a mean StomaQOL score of 52.56.

CLINICAL IMPLICATIONS

Optimal management should include, at least, routine assessment of sexual function prior to simple cystectomy and screening for sexual dysfunction during follow-up. Strengths and limitations The main strength of this study lies in the use of validated standardized questionnaires, including the FSFI that is considered as the most relevant tool for assessing female sexual function. Limitations include the small number of patients and the potential memory bias.

CONCLUSION

The present study suggests the urinary diversion mode has an impact on sexual function and body image after cystectomy for benign condition. Louar M, Morel-Journel N, Ruffion A, et al. Female Sexual Function and Body Image After Urinary Diversion for Benign Conditions. J Sex Med 2022;19:263-269.

Comparing Provider-Led Sexual Health Counseling of Male and Female Patients Undergoing Radical Cystectomy

BACKGROUND

Sexual dysfunction is a common quality-of-life issue among patients undergoing radical cystectomy (RC) for bladder cancer, but patients report deficiencies in sexual health counseling.

AIM

We sought to characterize provider-led sexual health counseling of patients undergoing RC and whether provider practice differs by patient gender.

METHODS

We conducted a cross-sectional survey of members of the Society of Urologic Oncology to assess topics included in provider-led sexual health counseling and barriers to counseling.

OUTCOMES

Nonroutine counseling regarding each sexual health topic was compared for female vs male patients using chi-squared tests. Modified Poisson regression was used to examine associations between provider characteristics and nonroutine counseling of female patients.

RESULTS

Among 140 urologists, the majority did not routinely counsel patients about sexual orientation, partner sexual dysfunction, or referral options to sexual health services. Providers were significantly more likely to not provide routine counseling to female patients compared to male patients about the following topics: baseline sexual activity (20.6% vs 9.7%, respectively, P = 0.04), baseline sexual dysfunction (60.8% vs 20.2%, respectively, P < 0.05), the risk of sexual dysfunction after RC (20.0% vs 6.5%, respectively, P = 0.006), the potential for nerve-sparing RC (70.8% vs 35.5%, respectively, P = 0.002), and postoperative sexual health and dysfunction (42.6% vs 21.1%, respectively, P = 0.01). Overall, 41.2% of providers did not routinely discuss the potential for pelvic organ-preserving RC with sexually active female patients. Provider sex, age, practice type, urologic oncology fellowship training, years in practice, or female RC volume were not predictive of nonroutine or disparate counseling of female patients. The most common barriers to counseling female patients were older patient age (50.7%), inadequate time (47.1%), and uncertainty about baseline sexual function (37.1%).

CLINICAL IMPLICATIONS

Urologists acknowledge key deficiencies and gender disparities in sexual health counseling of patients undergoing RC.

STRENGTHS AND LIMITATIONS

Although cross-sectional, to our knowledge, this is the first study to examine provider practice patterns regarding sexual health counseling of patients undergoing RC.

CONCLUSION

Future efforts should be directed towards reducing barriers to sexual health counseling of patients undergoing RC to improve deficiencies and gender disparities. Gupta N, Kucirka LM, Semerjian A, et al. Comparing Provider-Led Sexual Health Counseling of Male and Female Patients Undergoing Radical Cystectomy. J Sex Med 2020;17:949-956.

Sexual Function after Surgery for Prostate or Bladder Cancer

Background

Compromised sexual function is often a side effect for patients following radical surgical procedures for bladder or prostate cancer.

Methods

The authors review the classification and physiology of sexual function and dysfunction. Moreover, they explain the possible pathophysiology directly resulting from surgery, and they discuss several approaches available to address these problems.

Results

Options for male sexual dysfunction, primarily erectile dysfunction resulting from radical prostatectomy or surgery for bladder cancer, range from patient education to penile prosthesis implantation. Female sexual dysfunction caused by surgical intervention for bladder cancer includes problems with libido, arousal, orgasm, and dyspareunia. Treatment options for women can include sex therapy, hormonal therapy, and preventive strategies. However, no consensus has been established on the most effective agents and time points to treat male or female sexual dysfunction following radical cystectomies or prostatectomies. The chronic intermittent treatment of erectile dysfunction following radical prostatectomy has been commonly referred to as penile rehabilitation.

Conclusions

Additional research is needed to obtain further data concerning sexual dysfunction in both men and women following radical pelvic surgeries. Modification of surgical techniques, the use of various treatment modalities for sexual dysfunction, and the development of new agents will help to successfully minimize or prevent damage and restore normal sexual function after local surgical therapy for prostate or bladder cancer in the future.

The primary health care physician and the cancer patient: tips and strategies for managing sexual health

There is a large and growing population of long-term cancer survivors. Primary care physicians (PCPs) are playing an increasingly greater role in the care of these patients across the continuum of cancer survivorship. In this role, PCPs are faced with the responsibility of managing a range of medical and psychosocial late effects of cancer treatment. In particular, the sexual side effects of treatment which are common and have significant impact on quality of life for the cancer survivor, often go unaddressed. This is an area of clinical care and research that has received increasing attention, highlighted by the presentation of this special issue on Cancer and Sexual Health. The aims of this review are 3-fold. First, we seek to overview common presentations of sexual dysfunction related to major cancer diagnoses in order to give the PCP a sense of the medical issues that the survivor may present with. Barriers to communication about sexual health issues between patient/PCPs in order are also described in order to emphasize the importance of PCPs initiating this important conversation. Next, we provide strategies and resources to help guide the PCP in the management of sexual dysfunction in cancer survivors. Finally, we discuss case examples of survivorship sexual health issues and highlight the role that a PCP can play in each of these case examples.

Evaluating sexual function in women after radical cystectomy as treatment for bladder cancer

OBJECTIVE

Sexual function remains a relatively unexplored field within urology, especially for female patients who have undergone radical cystectomy (RC). The aim of this study was to shed light on this area.

MATERIALS AND METHODS

The Female Sexual Function Index (FSFI) questionnaire and other selective questions regarding sexual function were sent to 71 women who had undergone RC and were alive 1 year postsurgery. Forty-one completed questionnaires were returned and analysed using simple descriptive statistical analysis, owing to the small sample size.

RESULTS

The median age of the patients was 67 years (range 39-91 years). Seventy-eight per cent reported being sexually active before surgery and 37% post-surgery. The median FSFI score postsurgery was 4.8 (range 1.2-32). The highest FSFI score was seen in the category of satisfaction, which consists of questions regarding closeness with partner, sexual relationship and overall sex life. Lowest FSFI scores were seen for lubrication, orgasm and pain. Twenty-seven per cent of patients wanted more information on the impact RC would have on their sex lives and many asked for information for their partners.

CONCLUSION

Despite being based on a limited number of patients, this study indicates a need for improvement within this field. Most patients scored below 26 on the FSFI questionnaire, the cut-off for sexual dysfunction. However, many reported being satisfied overall. Thus, the physician's main goal is to identify patients in need of more information and guidance before and after surgery.

Sexual function after urinary incontinence surgery

Urinary incontinence (UI) affects between 42 and 71% of women. Sexual dysfunction is prevalent in the general population, but in women with UI, the prevalence is greater (42-56%). This review assesses the effects of urinary continence surgery on the sexual function of women with UI. Stress UI is surgically mostly managed via Burch colposuspension or a mid-urethral sling. These operations are as effective as each other with regards to maintaining or improving in sexual function. One of the main risks of these operations are that urgency UI (UUI) may be exacerbated or arise de novo and this has been shown to decrease sexual function. Severe refractory UUI requires complex surgery, such as percutaneous sacral nerve stimulation (SNS) then augmentation cystoplasty or urinary diversion. SNS may improve sexual function by direct action on the pudendal nerve as well as improving incontinence. Urinary diversion and augmentation cystoplasty are procedures of last resort in women who are refractory to all other UUI treatments. The majority of women report no change or improvement in sexual function as the urinary diversion negates the requirement for incontinence pads and indwelling catheters. Deteriorated sexual function has also been described in up to 37.5%. Thirty percent of women undergoing urinary diversion would have liked more 'sexological' counselling.

CONCLUSION

The majority of women enjoy maintained or improved sexual function after surgical treatment of UI. It is important to ensure women have appropriate pre-operative assessment and counselling so they may be advised of the risks of failed surgery including deteriorated sexual function.

Orthotopic bladder substitution (Neobladder): part II: postoperative complications, management, and long-term follow-up

Bladder replacement following radical cystectomy is widely practiced and in some centers has become the standard method of urinary diversion when possible, rather than the traditional ileal conduit. To minimize the impact of cystectomy and bladder replacement on quality of life and to obtain optimal functional results, postoperative care must be comprehensive and multidisciplinary. Critical team members include the surgeon, urologic nurses, WOC nurses, and allied health care providers such as physiotherapists. This article highlights postoperative considerations for patients undergoing radical cystectomy with orthotopic neobladder construction. The common issues and complications that arise are discussed with a focus on strategies to optimize outcomes.

Orthotopic bladder substitution (neobladder): part I: indications, patient selection, preoperative education, and counseling

Bladder substitution following radical cystectomy for urothelial cancer (transitional cell carcinoma) has become increasingly common and in many centers has evolved to become the standard method of urinary diversion. In determining the best type of urinary diversion for a specific patient, consideration must be given to both the morbidity associated with surgery and the potential positive impact on the patient's quality of life. Decision-making and perioperative care is ideally multidisciplinary, involving physicians and nurse specialists in urology, continence, and ostomy therapy. Physiotherapists may also be involved for pelvic floor muscle retraining. This article highlights preoperative considerations for patients undergoing radical cystectomy with a focus on issues specific to orthotopic bladder substitution as the method of urinary diversion. The second article in this 2-part series will outline postoperative strategies to manage these patients.

Ileal neobladder in women with bladder cancer: cancer control and functional aspects

PURPOSE OF REVIEW

Radical cystectomy and urinary diversion is the accepted standard of care for invasive bladder cancer. Although orthotopic neobladder is the preferred method of urinary diversion in men, less experience is available for women. Recent studies and reports on this subject are summarized and reviewed.

RECENT FINDINGS

Urethra-sparing cystectomy in women and orthotopic urinary diversion can be performed safely in appropriately selected women with invasive bladder cancer. Excellent oncological outcomes can be expected with a minimal risk of urethral recurrence in case of negative frozen section of the proximal urethra. Orthotopic neobladder diversion offers excellent clinical and functional results, and should be the diversion of choice in most women following cystectomy. Female sexual dysfunction can be avoided in patients who received neurovascular preservation, although quality of life declined in women who had undergone non-nerve-sparing radical cystectomy.

SUMMARY

Urethra-sparing cystectomy does not compromise the oncologic outcome in women with bladder cancer. The excellent functional outcome and voiding pattern with orthotopic urinary diversion argues in favor of this technique as the preferred method for lower urinary tract reconstruction after radical cystectomy. Nerve-sparing radical cystectomy preserves female sexual function and improves quality of life.

Female sexual dysfunction: classification, pathophysiology, and management

Female sexual dysfunction is a prevalent problem in the general community; however, it has not been studied as extensively as male sexual dysfunction. Female sexual dysfunction is a common complication after most pelvic surgeries. With the introduction of screening programs, most pelvic malignancies are detected at earlier stages and in younger patients. Sexual dysfunction is a major quality-of-life issue in these young women. Hysterectomy (simple or radical) is the most common type of pelvic surgery in women and is one of the most important causes of female sexual dysfunction. Additionally, female sexual dysfunction is an important issue after urologic (radical cystectomy) and colorectal surgeries (simple and radical proctocolectomy). Sexual dysfunction is a common problem among postmenopausal women. Modifications in the surgical technique (nerve sparing) are rapidly evolving in the field of urology and colorectal surgery, which will be soon followed by modifications in the field of gynecologic surgery. In this article we summarize the pathophysiology and classification of female sexual dysfunction, with special emphasis on the relationship between female sexual dysfunction and pelvic surgeries.

Female sexual function and activity following cystectomy and continent urinary tract diversion for benign indications: a clinical pilot study and review of literature

INTRODUCTION

There are limited data on female sexual function after cystectomy for benign indications.

AIMS

To evaluate postoperative sexual items following cystectomy and continent urinary diversion for benign indications (e.g., severe incontinence, interstitial cystitis) in female patients. Furthermore, to review the studies investigating changes in women's sexual function after cystectomy.

METHODS

In a retrospective study, 21 out of 23 patients (91%) who underwent a cystectomy for a benign indication completed a questionnaire. These women had a median age at the date of operation of 47.3 years (range 25-66 years) and a mean follow-up of 11.9 years. Questions on preoperative and postoperative sexuality, postoperative sexual activity, sexual appreciation, and the Female Sexual Function Index (FSFI) in patients at present were evaluated. Electronic databases were searched for the published studies investigating female sexual function after cystectomy.

MAIN OUTCOME MEASURES

Female sexual function was evaluated by the FSFI domain scores and postoperative sexual appreciation questions.

RESULTS

Sexual complaints before operation were present in 48% of the patients. The most common complaints reported were incontinence during intercourse, pain, and loss of libido. Seventeen out of 21 patients (81%) were sexually active preoperatively, 14 were still active postoperatively, and two preoperative inactive patients became active. Sexual inactivity postoperatively is mainly due to patient-related or combination of patient- and partner-related issues (70%), such as with pain during intercourse, loss of libido, and impaired body image. In the sexually active group, the majority (62.5%) showed improved or unchanged intercourse postoperatively. In the FSFI in 11 sexually active patients (52%) at present, domains of desire, arousal, lubrication, orgasm, and pain scored above average. The domain of satisfaction scored below average.

CONCLUSIONS

Despite extensive surgery, female sexuality may remain unchanged or even improve, following cystectomy and continent diversion for benign indication. Sexual inactivity postoperatively needs more attention in respect to sexual counseling. Overall, the results are reassuring.

Sexual dysfunction after pelvic surgery

Pelvic surgeries are among the most common causes of organic sexual dysfunction in men and women. The impact of nerve-sparing surgery on potency has been well documented in radical prostatectomy. However, its impact on potency needs to be evaluated in other pelvic surgeries. Sexual dysfunction is highly prevalent even after multiple technical advances in the field of oncological surgeries. The prevalence varies from 8 to 82%, depending on the type of pelvic surgery. In females, sexual dysfunction has not been evaluated adequately using validated questionnaires. However, in subspecialized circles, treatment for female sexual dysfunction is becoming routine. Currently, physicians have several options for the treatment of erectile dysfunction (ED) in men. Since the introduction of oral PDE-5 inhibitors, oral therapy has become the first-line treatment option for ED, irrespective of etiology. Currently available treatment options for the female sexual dysfunction include estrogens, androgens, phosphodiesterase inhibitors, and dopamine receptor antagonists. Initial reports regarding the role of early rehabilitation are encouraging and may become the part of routine practice in the management of ED after pelvic surgery. In this article, we summarize the sexual dysfunction following pelvic surgeries and their management.

Women's sexual dysfunction: a review of the "surgical landscape"

OBJECTIVES

To assess the impact of urogynaecologic surgery for stress urinary incontinence, oncologic pelvic surgery, and hysterectomy on women's overall sexual health.

METHODS

We used Ovid and PubMed (updated January 2006) to conduct a literature electronic search on MEDLINE that included peer-reviewed English-language articles. We analysed all studies identified that provided any functional outcome data about urogynaecologic surgery for the treatment of stress urinary incontinence, radical cystectomy for bladder cancer, surgery for rectal cancer, and hysterectomy. Because of the substantial heterogeneity of outcome measures and follow-up intervals in case studies, we did not apply meta-analytic techniques to the data.

RESULTS

Most studies showed that either urogynaecologic or oncologic pelvic surgery may have a significant impact on women's sexual health. Epidemiology varied widely among the studies and reported either improvement or impairment of postoperative sexual functioning, due to different definitions, study designs, and small cohorts of patients. An increasing number of studies have prospectively examined this issue and have found often controversial findings about the role of pelvic and perineal surgery in women's sexual health.

CONCLUSIONS

Although numerous controversies exist, data demonstrate an overall positive impact of the surgical repair for stress urinary incontinence on resolution of coital incontinence, coupled with an improvement of overall sexual life. In contrast, genitourinary and rectal cancers are commonly associated with treatment-related sexual dysfunction, but few studies rigorously assessed women's postoperative sexual function after major oncologic pelvic surgery. Data about the functional outcome after hysterectomy are often contradictory. Adequately powered prospective clinical trials are needed.

The role of the urologist in the management of female sexual dysfunctions

PURPOSE OF REVIEW

The present minireview is aimed at investigating the association between female sexual dysfunction and urinary incontinence or lower urinary tract symptoms, two of the most frequently encountered urological disorders.

RECENT FINDINGS

Sexual dysfunction in women is a multifactorial and multidimensional condition combining several biological, psychological, medical, interpersonal and social components. According to the National Health and Social Life Survey, approximately 43% of American women suffer from sexual disorders. There have been few investigations about the prevalence and predictors of female sexual function or sexual dysfunction across Europe. Based on everyday clinical practice and according to the most recent peer-reviewed publications, there is a critical correlation between urogynaecological conditions and women's sexual disorders. Interestingly, an increasing number of papers have raised the issue of women's sexual function in patients who have undergone urogynaecological radical pelvic surgery for urological malignancies. The role of the urologist in treating the couple covers the third part of this paper, and attempts to show the significant correlation between the presence of any female sexual dysfunction and so-called patient-partner satisfaction.

SUMMARY

This minireview underlines the significant role of the urologist in the management of female sexual dysfunctions, mainly in women with urogynaecological disorders. Evaluation by the patient's partner and its impact on urological patients has also been stressed.

Sexual function after partial cystectomy and urothelial stripping in a 32-year-old woman with radiation cystitis

We report a case of a 32-year-old woman who underwent a partial cystectomy to preserve sexual function. After radiotherapy for stage IB1 cervical cancer, cystectomy was indicated because of severe radiation cystitis. During this procedure we resected the upper part of the bladder followed by stripping off urothelium of the remaining bladder to spare the neurovascular bundle. Follow-up after 3 months indicated intact sexual function including orgasm. In our opinion the cystectomy procedure described in this case report is a good, novel option in women who are candidates for cystectomy because of a crippled bladder, after radiotherapy, and want to retain sexual function.

ORIGINAL RESEARCH—PATHOPHYSIOLOGY: Clinical Biologic Pathophysiologies of Women's Sexual Dysfunction

INTRODUCTION

Data concerning the biologic pathophysiology of desire, arousal, and orgasm in women are limited.

AIM

To gain knowledge of biologic pathophysiology of female sexual function. METHODS. To provide state-of-the-art knowledge concerning female sexual dysfunction, representing the opinions of seven experts from five countries developed in a consensus process over a 2-year period.

MAIN OUTCOME MEASURE

An International Consultation in alliance with key urological and sexual medicine societies convened over 200 multidisciplinary specialists from 60 countries into 17 consultation committees. The aims, goals and intentions of each committee were defined. Expert opinion was based on grading of evidence-based medical literature, extensive internal committee dialogue, open presentation, and debate.

RESULTS

Three critical physiologic requirements, including intact sex steroids, autonomic/somatic nerves, and arterial inflow/perfusion pressure to women's genital organs play fundamental roles in maintaining women's sexual function. Despite this, there are nominal data supporting a direct pathophysiologic involvement of abnormal sex steroid values, and/or damage/injury to neurologic and/or blood flow integrity in women with problems in sexual desire, arousal, and/or orgasm. This summary details the available literature concerning hormonal, neurologic, and vascular organic pathophysiologies of women's sexual dysfunctions.

CONCLUSIONS

Additional research on clinical pathophysiologies in women's sexual dysfunction is needed. This chapter encompasses data presented at the 2nd International Consultation on Sexual Medicine in Paris, France, June 28-July 1, 2003.

CYSTECTOMY AND ORTHOTOPIC ILEAL NEOBLADDER: THE IMPACT ON FEMALE SEXUALITY

PURPOSE

January 1986 and September 2003 cystectomy and formation of an ileal neobladder were performed in 86 female patients. In this retrospective study we focused on the impact of orthotopic reconstruction on female sexuality.

MATERIALS AND METHODS

To assess female sexuality the standardized self-reporting instrument female sexual function index was mailed to 44 patients who were 70 years or younger at cystectomy with a recurrence-free followup of greater than 1 year, no pelvic irradiation and no concomitant diseases impairing sexual functions. The questionnaire analyzes 6 domains (desire, arousal, lubrication, orgasm, satisfaction and pain) with 19 items. It was returned by 29 patients (65.9%) with a median age of 65.0 years. The indication for cystectomy was benign disease in 8 cases and malignancy in 21.

RESULTS

Factors influencing female sexuality were age younger than 60 years, benign disease, partnership at surgery and current partnership. Clean intermittent catheterization, urinary stress incontinence and hormonal therapy did not affect the results. The 11 of 17 patients who remained sexually active after cystectomy even had slight improvement in all female sexual function items. Six patients ceased to be sexually active postoperatively due to erectile dysfunction or partner death. One patient with interstitial cystitis became sexually active following cystectomy due to the loss of pelvic pain. Another 12 patients remained sexually inactive postoperatively.

CONCLUSIONS

All aspects of female sexuality may remain unchanged following cystectomy and ileal neobladder formation as long as sexual activity is not ceased due to other reasons. Even fertility can be preserved when the internal genitalia do not have to be removed.

Distressful symptoms and well-being after radical cystectomy and orthotopic bladder substitution compared with a matched control population

PURPOSE

We compared subjective quality of life, well-being, urinary tract symptoms and distress in patients after radical cystectomy and orthotopic urinary reconstruction with those in a matched control population.

MATERIALS AND METHODS

Included in this study were 101 consecutive recurrence-free patients who underwent radical cystectomy and orthotopic bladder substitution with an ileal urethral Kock neobladder at Herlev Hospital with a minimum followup of 1 year. A frequency matched control group comprising 147 individuals was selected from the same geographical region. Information was collected by an anonymous postal questionnaire and analyzed externally in Sweden.

RESULTS

The prevalence of low or moderate psychological well-being (32% versus 36%) and subjective quality of life (30% versus 38%), and high or moderate anxiety (23% versus 18%) and depression (26% versus 37%) was similar in patients with an orthotopic neobladder and population controls. Patients with a neobladder felt as attractive as the control population. Of the operated men 94% had erectile dysfunction compared with 48% of controls. Daytime and nighttime urinary frequency was similar in patients and controls (3% and 3%, and 15% and 13%, respectively), while the prevalence of urinary leakage at least once monthly was higher in patients (18% versus 5%). Intermittent self-catheterization was performed by 26% of patients with a neobladder. Urinary tract infection (14% versus 6%) was more common and the prevalence of distressful bowel symptoms (14% versus 9%) was slightly more common in patients than in controls.

CONCLUSIONS

Well-being and subjective quality of life in patients after radical cystectomy and orthotopic bladder substitution were similar to those in a matched control population.

[Quality of life in patients treated with orthotopic bladder substitution versus cutaneous ileostomy]

PURPOSE

Nowadays, psychcological and social aspects of treatment of urinary diversion after cystectomy, have become of utmost importance. Body image, potency, continence, emotional distress and dissatisfaction, functional and social activities are majors factors to improve quality of life after surgery. The aim of this study is to compare health-related quality of life after bladder substitution with ileal conduit diversion.

MATERIALS AND METHODS

We developed a questionnaire based upon a literature review, to compare health related quality of life between bladder substitution and ileal conduit (45 multiple choice mailed questionnaire). We examined functional and social activities, sexual dysfunction, urinary problems, and body image dissatisfaction.

RESULTS

78 male patients with bladder cancer, were interviewed. 91% of the questionnaires were answered, 48.7% by patients' family and 42.3% by the patients themselves. 6 patients underwent ileal conduit and 27 underwent bladder substitution. Patients with ileal consuit presented higher body image dissatisfaction than those who underwent bladder substitution. When urine leakage occurred it caused more distress to the conduit patients, indicating urinary leakage as their main problem. Bladder substitution patients did not consider continence problems as very important, they had not interrupted social activities such as travelling or seeing friends. 100% of bladder substitution patients would not mind to undergo this operation again, while only 66% of ileal conduit patients would.

CONCLUSION

Health-related quality of life is higher after bladder substitution. In our opinion we should use bladder substitution as the standard method of diversion after radical cystectomy for bladder cancer.