Sexuality Preserving Cystectomy and Neobladder: Initial Results

Horenblas, Simon; Meinhardt, W.; Ijzerman, Willem; Moonen, L.

doi:10.1016/s0022-5347(05)65847-8

Cited by 89 publications

(61 citation statements)

References 12 publications

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“…In a series of 13 patients (10 males, 3 females), Horenblass reported that 7/10 men who underwent surgery with this modification had return of normal erections on Rigiscan measurement and all women (3/3) reported normal vaginal lubrication. 34 In a later update, this group reported that 20/24 males were sexually active with or without erectaids and concluded that Sexual dysfunction after pelvic surgery C Zippe et al preservation of the prostate and neurovascular pedicle led to improved sexual function. 35 The oncologic concern with this procedure is that prostatic urethra and seminal vesicles can be a potential site for recurrence.…”

Section: Ed In Malesmentioning

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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Section: Ed In Malesmentioning

confidence: 99%

Sexual dysfunction after pelvic surgery

et al. 2005

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“…To lower the risk of future malignancy following prostatesparing cystectomy, strict screening protocols are used to rule out adenocarcinoma and urothelial carcinoma of the prostate before surgery. 6 These measures do not preclude future development of malignancies, and definitive treatment can be more challenging following cystectomy given the loss of tissue planes and peri-prostatic inflammatory and fibrotic changes that occur with requisite urine leakage following the original prostate-sparing cystectomy neobladder surgery. Additionally, the anticipated benefit in erectile function and urinary continence has not been ascertained.…”

Section: Introductionmentioning

confidence: 99%

The incidence of prostate cancer and urothelial cancer in the prostate in cystoprostatectomy specimens in a tertiary care Canadian centre

Sivalingam

Drachenberg

2013

CUAJ

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Introduction: Radical cystoprostatectomy remains the gold standard treatment for muscle invasive bladder cancer. However, given the treatment related complications of compromised potency and continence with this procedure, prostate/sexuality sparing cystectomy in orthotopic neobladder candidates has emerged in an effort to minimize these quality of life concerns. Recent evidence suggests only a marginal functional benefit from these technical refinements. We sought to determine the incidence of occult prostate cancer and urothelial cancer of the prostate in cystoprostatectomy specimens conducted for muscle invasive bladder cancer. Methods: We retrospectively reviewed 83 male patients who underwent radical cystoprostatectomy for muscle invasive bladder cancer between April 2004 and March 2007. The median age of our study group was 71 years. Pathologic findings of prostate/urothelial cancer in the prostate were identified. Clinically significant prostate cancer was defined as Gleason score >6, tumour volume >0.5cc, extracapsular extension or perineural invasion. Results: Our review yielded a 30% (±10%, 0.95 CI) rate of prostate cancer, with 19% (± 8.5%, 0.95 CI) of total specimens being positive for clinically significant prostate cancer. Urothelial cancer in the prostate was identified in 16% (±8.5%, 0.95 CI) of patients, with an overlap with prostate cancer in 2 patients. The overall rate of an underlying cancer within the prostate of our cystoprostatectomy specimens was about 46% (±10.7%, 0.95 CI). Conclusion: These findings suggest that the oncological risk of leaving behind residual cancer may not justify the practice of prostatesparing cystectomies.

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“…There has been considerable interest in urethral-sparing cystectomy and preservation of the gynecological tract to maintain continence mechanism, sexual function, and reproductive function in young patients who undergo radical cystectomy for muscle-invasive bladder cancer and gained acceptance in many centers [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

“…The issue of oncological safety of a urethra and anterior vaginal wall-sparing cystectomy in selected patients has been addressed by several authors [2][3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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Genital Organs-Sparing Radical Cystectomy in Female Patients with Muscle Invasive Urothelial Carcinoma of the Bladder

Salem¹

2017

Bladder Cancer - Management of NMI and Muscle-Invasive Cancer

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There has been considerable interest in urethral-sparing cystectomy and preservation of the gynecological tract to maintain continence mechanism, sexual function, and reproductive function in young patients who undergo radical cystectomy for muscle-invasive bladder cancer and this new technique gained acceptance in many centers. The issue of oncological safety of a urethra and anterior vaginal wall-sparing cystectomy in selected patients has been addressed by several authors. The chapter will discuss the following items: (

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Sexuality Preserving Cystectomy and Neobladder: Initial Results

Abstract: Sexuality preserving cystectomy and neobladder achieves maximal tissue conservation, resulting in preserved normal sexual function and satisfactory urinary tract reconstruction. Using strict criteria oncological results have not been jeopardized to date.

Cited by 89 publications

References 12 publications

Sexual dysfunction after pelvic surgery

Sexual dysfunction after pelvic surgery

The incidence of prostate cancer and urothelial cancer in the prostate in cystoprostatectomy specimens in a tertiary care Canadian centre

Genital Organs-Sparing Radical Cystectomy in Female Patients with Muscle Invasive Urothelial Carcinoma of the Bladder

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