Attempted Nerve Sparing Surgery and Age Have a Significant Effect on Urinary Continence and Erectile Function After Radical Cystoprostatectomy and Ileal Orthotopic Bladder Substitution

Kessler, Thomas M.; Burkhard, Fiona C.; Perimenis, Petros; Danuser, Hansjörg; Thalmann, George N.; Hochreiter, Werner W.; Studer, Urs E.

doi:10.1097/01.ju.0000138249.31644.ec

Cited by 189 publications

(119 citation statements)

References 16 publications

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“…12 Also, with unilateral and bilateral nerve-sparing cystectomy, potency rates of 33% and 60% can be achieved. 13 These results are comparable to radiation therapy, with 54% of these patients having adequate erections. 14 There is also recent interest on the importance of lymphadenectomy and its therapeutic and prognostic value.…”

Section: Radical Cystectomy For Muscle-invasive Bladder Cancersupporting

confidence: 66%

Radical cystectomy is the treatment of choice for invasive bladder cancer

Yafi

Kassouf

2013

CUAJ

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Section: Radical Cystectomy For Muscle-invasive Bladder Cancersupporting

confidence: 66%

Radical cystectomy is the treatment of choice for invasive bladder cancer

Yafi

Kassouf

2013

CUAJ

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“…They further reported recently that preservation of the neurovascular pedicle was associated with significant improvement in recovery of erectile function. 46 This pioneering work by Studer and colleagues has made the urologists realize the importance of nerve-sparing surgery in female RC. Our surgical modifications include:…”

Section: Sexual Dysfunction In Femalesmentioning

confidence: 99%

Sexual dysfunction after pelvic surgery

et al. 2005

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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. International Journal of Impotence Research (2006) IntroductionErectile dysfunction (ED) is defined as the inability to achieve and maintain an erection sufficient for satisfactory sexual intercourse. 1 Several factors have been implicated in the etiology of ED. Vascular and neurogenic causes are the most common among them. Diabetes, smoking and hypertension are the most important risk factors for vasculogenic sexual dysfunction. Neurological dysfunction is mainly associated with certain neurological syndromes like autonomic neuropathy. Sexual dysfunction after pelvic surgery has been an important and underreported cause of ED. The pathophysiology of sexual dysfunction after pelvic surgery is unique because it can be either vascular or neurogenic factors alone, or a combination of both. The pelvic surgeries in males that are associated with considerable ED include radical prostatectomy (RP), radical cystoprostatectomy (cystectomy) and low anterior or abdominoperineal resections (APRs) for rectal cancer. The pelvic surgeries in females associated with sexual dysfunction include radical cystectomy (RC) for bladder cancer, radical hysterectomy for cancers of the cervix and endometrium and, potentially, simple hysterectomy for benign tumors.In this article, we summarize male and female sexual dysfunction following pelvic surgeries for prostate, bladder and rectal cancer. We also discuss our experience in the treatment of sexual dysfunction following RP and RC. than 10%, urologists still report that the majority of patients experience ED following RRP. [3][4][5] Until recently, ED following RP was not an overwhelming concern, as most prostate cancers were detected in older men. 6 However, since the adven...

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“…También encontraron que la continencia es significativamente mayor en aquellos pacientes en los que se hizo preservación nerviosa 27 .…”

Section: Continencia Nocturnaunclassified

“…De nuevo en la serie de la Universidad de Berna, encontramos un porcentaje de pacientes con erecciones postoperatorias del 22,4% sin medicación y del 15% con algún tipo de tratamiento para la DE. La edad del paciente y la técnica de preservación nerviosa se mostraron como factores protectores frente a la DE 17,27 Retención urinaria En los pacientes con neovejiga ileal, la micción se produce mediante la relajación del suelo pélvico. El uso de la maniobra de Valsalva de forma suave al final de la micción puede acelerar el vaciado pero no supone un factor clave.…”

Section: Función Eréctilunclassified

Manejo perioperatorio y resultados en pacientes con neovejiga ileal ortotópica: Postoperative management and results

Ardura¹,

Abarca²,

Studer

2008

Actas Urol Esp

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RESUMENMANEJO PERIOPERATORIO Y RESULTADOS EN PACIENTES CON NEOVEJIGA ILEAL ORTOTÓPICA La reconstrucción del tracto urinario tras la cistectomía radical ha evolucionado desde la simple derivación urinaria hasta la reconstrucción anatómica y funcional del mismo lo más próxima posible al estado preoperatorio del paciente. En los últimos 20 años, la reconstrucción ortotópica ha pasado de cirugía experimental a ser el método preferido de derivación urinaria en ambos sexos. Los urólogos que realizan este tipo de intervención deben tener experiencia en cirugía pélvica y ser capaces de realizar una cistectomía con preservación nerviosa. Sin embargo, lo más importante en estos enfermos es el manejo postoperatorio, para lo cual se requiere un profundo conocimiento de la fisiología de la neovejiga, sus posibles complicaciones y tratamientos. Revisamos en este artículo los principales aspectos del manejo postoperatorio de los pacientes con neovejiga ileal. También se revisan los resultados de la técnica a largo plazo con respecto a continencia, función sexual, preservación de función renal, control oncológico y calidad de vida de los pacientes. ABSTRACT ORTHOTOPIC ILEAL NEOBLADDER. POSTOPERATIVE MANAGEMENT AND RESULTSUrinary diversion after cystectomy have evolved from simple diversion and protection of the upper tracts to functional and anatomic restoration as close as possible to the natural preoperative state. Over the past 15 years, orthotopic reconstruction has evolved from "experimental surgery" to the "preferred method of urinary diversion" in both sexes. Urologist that perform this technique should have an appropriate experience with pelvic surgery and be able to perform a nerve sparing radical cystectomy. Nevertheless, the postoperative management of these patients is more important than the surgical construction if good longterm results are to be achieved. For this reason, a great knowledge about the neobladder´s physiology, postoperative complications and their treatment are needed. We review the most important aspects in the postoperative management of patients with ileal neobladder. We also resume the long term outcomes concerning to continence, sexual function, renal impairment, oncologic safety and quality of life.

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Attempted Nerve Sparing Surgery and Age Have a Significant Effect on Urinary Continence and Erectile Function After Radical Cystoprostatectomy and Ileal Orthotopic Bladder Substitution

Cited by 189 publications

References 16 publications

Radical cystectomy is the treatment of choice for invasive bladder cancer

Radical cystectomy is the treatment of choice for invasive bladder cancer

Sexual dysfunction after pelvic surgery

Manejo perioperatorio y resultados en pacientes con neovejiga ileal ortotópica: Postoperative management and results

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