Sexual Function after Non-Nerve-Sparing Radical Cystoprostatectomy: A Comparison between Ileal Conduit Urinary Diversion and Orthotopic Ileal Neobladder Substitution

Abstract

Objective: To compare the erectile function (EF) and sexual desire (SD) in men after radical cystoprostatectomy (RCP) who had either an ileal conduit urinary diversion or orthotropic ileal neobladder substitution. Materials and Methods: Eighty one sexually active men with bladder cancer were enrolled in this prospective study. After RCP according to patients' preferences they underwent either ileal conduit urinary diversion (n = 41) or orthotropic ileal neobladder substitution (n = 40). EF and SD were assessed using International Index of Erectile Function (IIEF) questionnaire. Patients were assessed at 4-week before surgery and were followed up at 1, 6, and 12-month postoperatively using the same questionnaire. Results: Postoperatively the EF and SD domains deteriorated significantly in both groups, but in a small proportion of the patients submitted to ileal neobladder they gradually improved with time (P = 0.006). At 12-month postoperative period, 4 (9.8%) and 14 (35.0%) patients in ileal conduit and ileal neobladder groups were able to achieve erections hard enough for vaginal penetration and maintained their erection to completion of intercourse, respectively (P = 0.006). Among patients in the ileal conduit and ileal neobladder groups, additional 4 (9.8%) and 7 (17.1%) patients were able to get some erection, but were unable to maintain their erection to completion of intercourse (P = 0.02). At 12-month follow up period 24.4% of the ileal conduit and 45.0% of the ileal neobladder patients rated their sexual desire very high or high (P = 0.01).

Hypermethylated in cancer 1 (HIC1) suppresses bladder cancer progression by targeting yes‐associated protein (YAP) pathway

“…7 The 5-year survival rate of the traditional treatments is 62%, due to the frequent metastasis. 9 Therefore, the primary tasks of improving BCa treatment are to study its pathogenesis and to locate more effective therapeutic targets. 9 Therefore, the primary tasks of improving BCa treatment are to study its pathogenesis and to locate more effective therapeutic targets.…”

<p>Orthotopic Neobladder Reconstruction: Patient Selection And Perspectives</p>

“…The majority of studies examining sexual function have focused on male patients and predictors and prevalence of sexual function post-RC and ONB reconstruction. Traditionally, erectile function has been reported to be retained in between 24% and 36% of patients post-ONB reconstruction 33,50,51. However, RC approaches with neurovascular bundle preservation may help preserve erectile function.…”

Orthotopic neobladder reconstruction

“…found that men experienced significant deterioration in both erectile function and sexual desire postoperatively, irrespective of the type of urinary diversion performed. [ 26 ]…”

“…Between 23.7–35.5% of patients retain adequate erectile function after neobladder reconstruction. [ 15 20 26 ] Some studies demonstrated that neobladder reconstruction results in better preservation of sexual function when compared with an ileal conduit using the International Index of Erectile Function questionnaire. Specifically, 35.0% of men in the ileal neobladder group were able to achieve and maintain erections sufficient for vaginal penetration throughout sexual intercourse, compared with 9.8% of men in the ileal conduit group ( P = 0.006).…”

“…In addition, more men in the ileal neobladder group rated their sexual desire high or very high in comparison with men in the ileal conduit group (45.0% vs. 24.4%, P = 0.01). [ 26 ] Asgari et al . also found that more men with an ileal neobladder reported unaltered sexual desire compared with patients who had an ileal conduit (17.5% vs. 7.2%, P = 0.01).…”