A prospective randomized comparison of sexual function and semen analysis following laparoscopic totally extraperitoneal (TEP) and transabdominal pre-peritoneal (TAPP) inguinal hernia repair

BACKGROUND

With standardization of laparoscopic technique of groin hernia repair, the focus of surgical outcome has shifted to lesser studied parameters like sexual function and fertility.

METHODS

This prospective randomized study was conducted in a single surgical unit at a tertiary care hospital. A sample size of 144 was calculated with 72 in each group (Group 1 TEP and Group 2 TAPP). Primary outcomes measured included comparison of sexual function using BMFSI, qualitative semen analysis and ASA levels between patients undergoing TEP or TAPP repair. Semen analysis and ASA was measured pre-operatively and 3 months post-operatively.

RESULTS

A total of 145 patients were randomized into two groups, TAPP (73) and TEP (72) patients. Both the groups were comparable in terms of demographic profile and hernia characteristics with majority of the patients in both the groups having unilateral inguinal hernia (89.0% in TAPP group and 79.2% in TEP group). Both the groups showed statistically significant improvement in overall sexual function score (BMFSI) at 3 months; however, there was no inter group difference. Both the groups were also comparable in terms of ASA and qualitative semen analysis.

CONCLUSION

Both TEP and TAPP repair are comparable in terms of sexual function and effect on semen analysis. Laparoscopic repair improves the overall sexual functions in patients with groin hernia.

Sexual functions in pregnancy: different situations in near geography:a case study on Turkey, Iran and Greece

Purpose: This descriptive and cross-sectional study aims to determine the sexual function status of primipar and multipar pregnant women who admitted to birth clinics in Iran, Turkey and Greece and to investigate the relationship between pregnancy processes and some variables.Methodology: This descriptive and cross-sectional study population consisted of primipar/multipar pregnant women who met the research inclusion criteria, agreed to participate in the research and admitted to the Tabriz Pars Clinic in Iran, Izmir Aegean Maternity Hospital in Turkey and Thessaloniki University Hospital in Greece.Results: When the sexual problems of women are compared according to their countries,it was determined that 40% of Iranian women "can't easily share their sexuality issues with their spouses", whereas this rate was 8% in Turkey and 6.7% in Greece.Considering the prevalence of orgasmic and arousal disorder in the pre-pregnancy period,it was reported that this rate was 53% in Iran, 47% in Greece and 5.6% in Turkey.In the study, the mean "Female Sexual Function Index(FSFI)" score of Turkish women was found to be (59.83 ± 21.75), whereas the FSFI score of Iranian women was (62.86 ± 22.71) and mean FSFI score of the Greek women was (54.33 ± 21.15).Discussion: In the study, it was shown that there is a difference in the sexual problems of the women, depending on the religious and socio-cultural structure of the country they live in. For an effective case and training on sexuality,the norms and values of the society have to be understood in order to raise quality of lives and problem-free sexuality of pregnant women.

Assembling a Functional Clitoris and Vulva from a Pseudo-Penis: A Surgical Technique for an Adult Woman with Congenital Adrenal Hyperplasia

BACKGROUND

Congenital adrenal hyperplasia (CAH) is associated with a genital deformation that might cause a negative body image. The genital ambiguity is generally "corrected" surgically during early infancy. The advantage is a psychological benefit. The disadvantages are multiple surgical procedures and the loss of orgasm.

CASE

A 22-year-old woman with CAH consulted for genital reconstructive surgery. She had a pseudopenis of 4 cm and could achieve an orgasm by masturbating. During surgery, the penis was dismantled and with the preserved glans penis and the corpora cavernosa, a clitoris and vestibules were constructed, respectively. On the basis of the anamneses during the follow-up, she had a functional vagina and could still achieve orgasms.

SUMMARY AND CONCLUSION

Genital correction surgery for CAH at an older age was easier, could be done in 1 step, and enabled the preservation of orgasm.

Interrelationship between the general characteristics of Korean stroke patients and the variables of the sexual functions: random forest and boosting algorithm

[Purpose] The purpose of this study is to examine patient preferences for counseling related to sexuality post-stroke in Korea. [Subjects and Methods] A survey was conducted on 200 stroke patients. Among the 200 submitted questionnaires, 156 responded but 147 cases are available. The questionnaire is composed of 27 questions such as 8 independent variables related to the general characteristics of the patients, 7 dependent variables in conjunction with sexual intercourse and changed muscle tone, 6 questions regarding to changed sexual function, and 6 questions about a changed motor and a sensory function after stroke. To analyze the factors related to a sexual function after a stroke, we used the random forest, boosting algorithm and MANOVA. [Results] The most important variable in variable group 1 is VAR1, and then VAR22, VAR23, VAR26, VAR27, VAR25, VAR21 and VAR 24 respectively. The most important variable in variable group 2 is VAR22, and then VAR26, VAR23, VAR25, VAR1, VAR27, VAR21 and VAR 24. Finally, for variable group 3, VAR1 has the most important percentage, and we have the order as VAR26, VAR23, VAR27, VAR22, VAR25, VAR21 and VAR 24 among the rest of variables. The result of variable importance in boosting algorithm is somehow the same as that of random forest. [Conclusion] As a result of our analysis, we figured out that duration of illness, age, and education level are important factors of sexual functions for Korean Stroke patients.

A prospective randomized comparison of testicular functions, sexual functions and quality of life following laparoscopic totally extra-peritoneal (TEP) and trans-abdominal pre-peritoneal (TAPP) inguinal hernia repairs

BACKGROUND

There is very scant literature on the impact of inguinal hernia mesh repair on testicular functions and sexual functions following open and laparoscopic repair. The present randomized study compares TAPP and TEP repairs in terms of testicular functions, sexual functions, quality of life and chronic groin pain.

METHODS

This study was conducted from April 2012 to October 2014. A total of 160 patients with uncomplicated groin hernia were randomized to either trans-abdominal pre-peritoneal (TAPP) repair or totally extra-peritoneal (TEP) repair. Testicular functions were assessed by measuring testicular volume, testicular hormone levels preoperatively and at 3 months postoperatively. Sexual functions were assessed using BMSFI, and quality of life was assessed using WHO-QOL BREF scale preoperatively and at 3 and 6 months postoperatively. Chronic groin pain was evaluated using the VAS scale at 3 months, 6 months and at 1 year.

RESULTS

The median duration of follow-up was 13 months (range 6-18 months). The mean preoperative pain scores (p value 0.35) as well as the chronic groin pain were similar between TEP and TAPP repairs at 3 months (p value 0.06) and 6 months (p value 0.86). The testicular resistive index and testicular volume did not show any significant change at follow-up of 3 months (p value 0.9) in the study population. No significant difference was observed in testicular resistive index and testicular volume when comparing TEP and TAPP groups at at follow-up of 3 months (p value >0.05). There was a statistically significant improvement in the sexual drive score, erectile function and overall satisfaction over the follow-up period following laparoscopic inguinal hernia repair. However, sexual function improvement was similar in patients undergoing both TEP and TAPP repairs. All the domains of quality of life in the study population showed a significant improvement at a follow-up of 3 and 6 months. Subgroup analysis of all the domains of quality of life in both TAPP and TEP groups showed a similar increment as in the study population (p value <0.001); however, the mean scores of all the domains were comparable between the two subgroups (p value >0.05), preoperatively and 3 and 6 months follow-up.

CONCLUSIONS

Laparoscopic groin hernia repair improves the testicular functions, sexual functions and quality of life, but TEP and TAPP repairs are comparable in terms of these long-term outcomes.

[Sexual functions after treatment for rectal cancer: impact of doses in autonomic pelvic nerves]

PURPOSE

Prospective evaluation of sexual function after treatment of rectal cancer and identification of predictive factors.

PATIENTS AND METHODS

Thirty-three patients were treated with curative intent by chemoradiation and surgery for localized rectal adenocarcinoma. Sexual toxicity was assessed four times (before treatment and at 2, 6 and 12 months) using validated questionnaires: QLQ C30 and EORTC CR38 for all, simplified IIEF for men and FSFI for women. A correlation was sought between the toxicity and clinical and dosimetric parameters by Fisher and Mann-Whitney tests.

RESULTS

In men, erections and sexual satisfaction decreased significantly from the acute phase and then stabilized (respective scores of 84.5 and 86/100 in the initial phase, 66 and 70.4 at the end of radiotherapy, 70 and 70 at 6 months and 68.5 and 70 at 12 months). For women, the changes were not significant. This study confirms some risk factors for sexual toxicity already mentioned (original function, age, tumor volume) and highlights new (dose to the seminal vesicles and above all, doses to pelvic autonomic plexus).

CONCLUSION

Sexual effects of combined treatment of rectal cancer have only recently been described but remain undervalued and poorly understood. The impact of the autonomic pelvic plexus doses is a completely new data that could be extended in the development of intensity-modulated radiotherapy.