Changes in male sexuality after urologic cancer: a narrative review

ABSTRACT Objective To describe the most common sexual problems and changes experienced by male urological cancer survivors, focusing on evidence-based practices for assessment and intervention. Materials and Methods We search the PubMed, Embase, and SciELO databases between 1994 and 2022, using the following key words: "urological cancer", "urological malignances", "genitourinary cancer", "male sexual health", and "male sexual dysfunction". Results This narrative review provides an overview of the current literature involving the impact of diagnosis and treatment of urological cancers on male sexual function. Male "genital" or "reproductive" tumors, such as prostate, penile, and testicular tumors, clearly appear to affect sexual function. However, tumors that do not involve genital parts of the body, such as the bladder and kidney, can also affect male sexual function. Conclusion Male sexual dysfunction is very common after urologic cancer diagnosis and treatment. Changes in body image and anatomical damage can be associated with impaired masculinity and sexual function, especially after prostate, penile or testicular cancer treatment. Moreover, anxiety, depression, and fear of recurrence have an impact on quality of life and sexual function regardless of the cancer location. Therefore, patients need be counseled about the likely changes in sexual function before treatment of any urological cancer.

Impact of the COVID-19 pandemic on the urologist's clinical practice in Brazil: a management guideline proposal for low- and middle-income countries during the crisis period

This letter to the Editor aims to provide suggestions and recommendations for the management of urological conditions in times of COVID-19 crisis in Brazil and other low- and middle-income countries. It is important to highlight that one of the main characteristics of this pandemic is the oversaturation of the health system capacity, mostly due to a high demand for personal protective equipment (PPE), Hospital/ICU beds, as well as ventilators. In places with limited resources and where the health care systems are already saturated, such consideration is even more worrisome. Therefore, most worldwide authorities are recommending to avoid, as much as possible, patient's elective visits to hospitals, as well as a judicious use of the operating room in order to mitigate the strain put on the health system. While efforts should be directed to the care of COVID-19 patients, other conditions (especially urgencies and oncological cases) must continue to be assisted. Thus, through a panel of experts, we have prepared a practical guide for urologists based on the recommendations from the main Urologic Associations, as well as data from the literature to support the suggested management. We will try to follow the standard guideline recommendations from the American Urological Association (AUA) and European Association of Urology (EAU), with the aim of pursuing the best outcomes possible. However, some recommendations were based on the consensus of the panel, taking into consideration the reality of developing countries and the unprecedented situation caused by the COVID-19 crisis. Most importantly, all recommendations on this manuscript are based on the expectancy of a maximum 3-month duration of the crisis. If this period shall extended, these recommendations will be revised and updated. The format of the text will be given through questions and answers.(AU)