Purpose Near-infrared (NIR) fluorescence imaging is a promising technique that offers, real-time, visual information during surgery. The current study reports the first clinical results of ureter imaging using NIR fluorescence after a simple peripheral infusion of methylene blue (MB). Furthermore, optimal timing and dose of MB were assessed. Materials and Methods A total of 12 patients that underwent lower abdominal surgery were included in this prospective feasibility study. NIR fluorescence imaging was performed using the Mini-FLARE™ imaging system. To determine optimal timing and dose, MB was injected intravenously at doses of 0.25, 0.5 or 1 mg/kg, after exposure of the ureters. Subsequently imaging was performed for up to 60 min following injection. Results In all patients both ureters could be clearly visualized within 10 minutes after infusion of MB. Signal lasted at least up to 60 minutes after injection. The mean signal-to-background ratio (SBR) of the ureter was 2.27 ± 1.22 (N = 4), 2.61 ± 1.88 (N = 4) and 3.58 ± 3.36 (N = 4) for the 0.25, 0.5 and 1 mg/kg groups, respectively. A mixed model analysis was used to compare SBRs between dose groups and time points and to assess the relation between dose and time. A significant difference between time points (P < 0.001) was found. However no difference between dose groups was observed (P = 0.811). Conclusions This study demonstrates the first successful use of NIR fluorescence using low-dose MB for the identification of the ureters during lower abdominal surgery.

Findings suggest oncology nurses consider counselling on sexual issues to be an important responsibility, in line with discussing other side-effects caused by the disease or its treatment. Nevertheless, cancer patients may not routinely be receiving a sexual health evaluation by oncology nurses. Results emphasize the potential benefit of providing knowledge, including practical training and a complete department protocol.

Sexuality is not routinely discussed in the cardiology practice. Explanations for the lack of attention toward sexual matters are ambiguities about responsibility and a lack of time, training and experience regarding the communication and treatment of sexual dysfunction.

Introduction The transobturator suburethral tape (TOT) and tension-free vaginal tape obturator (TVT-O) procedures are relatively new incontinence treatment procedures. Studies on the influence on sexual function as a result of these procedures are limited. Aim The influence of TOT or TVT-O for the surgical treatment of stress urinary incontinence (SUI) on female sexual function. Methods We evaluated 77 sexually active patients after TVT-O (N=34, mean age 53.2 years) and TOT (OB-TAPE, Porges) (N=44, mean age 52.0 years) placement for SUI based on the responses to a mailed questionnaire 3 months after the operation. Main Outcome Measure Difference in postoperative sexual complaints related to the TVT-O (inside-out) and TOT (outside-in) procedure. Results Postoperative TOT and TVT-O: There was almost no difference in frequency of sexual intercourse and an improvement of the continence during intercourse; continence was reported in 33 patients (42.3%) before and 67 patients (78.4%) after operation. The appreciation of sexual intercourse was improved in 15 patients (19.2%) and worsened in eight patients (10.3%). Postoperative TVT-O vs. TOT: No difference was seen in lost of lubrication, clitoral tumescence reduction, and clitoral sensibility reduction between both procedures. Pain because of vaginal narrowing was seen significantly more in the TOT procedure group. Conclusion Overall, in this study, the technique of TOT gave rise to more sexual dysfunction than TVT-O. However, because of the successful outcome on incontinence, both procedures had, overall, a positive effect on sexual function. The cause of significant more pain during intercourse as a result of vaginal narrowing in the TOT procedure requires further investigation. Like other studies, this study demonstrated that incontinence surgery can have a positive and negative outcome on sexual function. It is important to put this issue in the informed consent.

This review offers an insight into the extent of micturition dysfunction, defecation dysfunction and sexual dysfunction (SD) in CES after decompression. Our findings show that dysfunction is extremely common, even at long-term follow-up. A condition as invalidating as CES requires proper patient information and the outcomes presented here may help in providing those data. Bias in included studies, lack of universal definitions and incomplete follow-up results qualify these data as the best we momentarily have, but still subject to improvement. Since SD seems to be severely underreported, we recommend further research to explore the extent of this problem, as well as the use of questionnaires in future clinical (prospective) studies to accomplish a more patient-based approach.

Surgical oncologists do not routinely discuss sexual concerns. Informed consent includes limited information about possible complications on sexual function. Surgeons consider themselves responsible for raising the issue of sexual dysfunction, but consider advanced age of patients, lack of time and no angle or motive for asking as major barriers. Results emphasize the need for raising awareness and providing practical training.

The transobturator sling suspension operation is a minimally invasive, safe procedure for male postoperative stress incontinence. Significantly improved continence was not observed on pad test but significant improvement in continence and bother was seen on the visual analog scale at 3 months.

Background Even though micturition, defecation, and sexual function are substantially affected in cauda equina syndrome (CES), data on outcome are scarce. Methods Medical files of patients operated on lumbar herniated disc were screened for CES and retrospectively analyzed for baseline characteristics, outcome of micturition, defecation, and sexual function and possible predictors. Results Seventy-five CES patients (52% men) were included with a mean age of 44 years. L5-S1 was the most common affected level. Duration of CES complaints at presentation was, on average, 84 h (median 48 h). Prevalence of symptoms at presentation: sciatica (97%), altered sensation of the saddle area (93%), micturition dysfunction (92%), and defecation dysfunction (74%). Only 26 patients were asked about sexual dysfunction of whom 25 patients experienced dysfunction. Female gender was associated with more defecation dysfunction at presentation than male gender (OR 4.11; p = 0.039). All patients underwent decompressive surgery. Two post-operative follow-up (FU) moments took place after a mean of 75 h and 63 days.Outcomes at second FU moment: micturition dysfunction 48%, defecation dysfunction 42%, sexual dysfunction 53%, sciatica 48%, and altered sensation of the saddle area 57%. A shorter time to decompression was associated with more sciatica at FU 1 (p = 0.042) which effect had disappeared at FU 2. Conclusion This study is unique in (1) displaying the presenting features in a large cohort of CES patients, (2) demonstrating that recovery after decompression is slow and far from complete in the majority of patients with regard to micturition, defecation, and sexual function and (3) evaluating predictors for outcome.