Sexological problems after cystectomy: bladder substitution compared with ileal conduit diversion. A questionnaire study of male patients.

A questionnaire study was carried out to compare the postoperative sexological problems after cystectomy and bladder substitution using the urethral Kock reservoir or the ileocecal reservoir with that following ileal conduit diversion. A total of 76 male patients with bladder cancer completed the questionnaire: 49 patients had a bladder substitution and 27 an ileal conduit diversion. Median follow-up was 1.3 years (range 0.5-6.4) and 4.8 years (range 2.4-14.7), respectively. Only 9% of all patients could achieve an erection at least every second time, in comparison to 82% preoperatively. Thirty-eight percent of all patients were able to achieve orgasm, and 26% were coitally active to some degree. Reasons for decrease or cessation of coitus were loss of potency among 77% and 96% respectively (p = 0.04), while those reporting decreased libido (29%), partner refusal (13%), and feeling less sexually attractive (20%) showed no between-group differences. Regression analysis showed no influence of type of operation, while age above 68 years influenced orgasmic ability and coital activity, and radiation treatment influenced whether the patient felt less sexually attractive than before surgery.

A questionnaire study of sexological problems following urinary diversion in the female patient.

A questionnaire study was conducted to evaluate the sexological problems after urinary diversion, using the continent Kock reservoir or the ileal conduit diversion. Thirty-seven female patients completed the questionnaire: 17 patients had a continent and 20 an ileal conduit diversion, with a median follow-up of 0.8 year (range 0.5-4.4) and 4.6 years (range 2.8-12.0), respectively. Data from only 33 patients were eligible for analysis, but no significant between-group differences were found. Coital frequency remained unchanged or increased among 44% of patients with a continent reservoir and among 18% of ileal conduit patients (p = 0.11). Among those reporting other than unchanged/increased activity almost one-third gave physical problems or decreased desire as the reason, and 30% felt less sexually attractive, with cystectomized patients reporting a higher percentage than others. A higher frequency of dyspareunia among patients with a continent reservoir was an unexpected finding (p = 0.06), and merits further investigation in a larger sample. Here it may be due to the shorter follow-up of these patients. Thirty per cent of all patients would have like more sexological counselling.

Health-related quality of life after cystectomy: bladder substitution compared with ileal conduit diversion. A questionnaire survey.

OBJECTIVE: To compare the health-related quality of life after bladder substitution with that following ileal conduit diversion. PATIENTS AND METHODS: Sixty-seven male patients with bladder cancer completed the questionnaire; 38 had undergone bladder substitution and 29 ileal conduit diversion; the median follow-up was 1.0 year (range 0.5-3.0) and 4.8 years (range 1.1-15.2), respectively. Semi-structured qualitative interviews were conducted and analysed, and the questionnaire was developed based upon these results. RESULTS: Both day- and night-time urinary leakage occurred more frequently following bladder substitution (18% against 10%, and 21% against 3%). Nevertheless, urinary leakage affected conduit patients more severely and they scored higher on a leakage distress scale. Furthermore, 58% of the ileal conduit but only 21% of the bladder substitution patients gave urinary leakage as their main concern (P = 0.04). Ileal conduit patients did not retain their body image as well as those with bladder substitution. The frequency of both sexual and non-sexual physical contacts decreased in the majority of the conduit patients but only in a minority of the bladder substitute patients. Global satisfaction was high and similar in both groups. CONCLUSION: These results show that the health-related quality of life is retained to a higher degree after bladder substitution and supports the use of this procedure as the standard method of diversion after cystectomy for bladder cancer.

Health-related quality of life after urinary diversion: continent diversion with the Kock pouch compared with ileal conduit. A questionnaire study.

A questionnaire study was carried out to compare the health-related quality of life after continent urinary diversion using a Kock pouch with that following ileal conduit diversion. 76 patients completed the questionnaire: 26 patients had a continent and 50 an ileal conduit diversion, median follow-up was 0.9 year (range 0.5-4.4) and 4.9 years (range 2.4-14.7), respectively. The type of operation carried significant relation to the presence of leakage distress associated with urine leakage; 78% among conduit patients versus 50% among continent diversion patients experienced distress. Physical contact between patient and partner was reduced significantly less following continent diversion: 16% against 43% among patients with conduit diversion. Global satisfaction with life was high and similar in the two groups. Continent urinary diversion appears to be superior to conventional ileal conduit diversion.

Sexual dysfunction in male and female patients with epilepsy: a study of 86 outpatients.

Sexual dysfunction is a well-known complication of chronic somatic illness. Eighty-six consecutive epileptic outpatients, 38 men and 48 women, without accompanying disorders, were studied. The frequency and symptoms of sexual dysfunction were compared with results from previous studies using identical sexological methodology. The previous studies were of diabetic patients and healthy controls. Eight percent of the epileptic men reported a sexual dysfunction compared to 44% of the diabetics and 13% of the controls. Epileptic women, diabetic women, and controls showed no significant differences in sexual dysfunction (29%, 28%, and 25%, respectively). In both sexes, the sexual function measured by frequencies of coitus and masturbation was normal. Most patients had good control of epileptic attacks on a treatment of monotherapy. Hormonal status was generally within normal limits in both men and women; only a few minor differences were found and they showed no correlation with sexual dysfunction. Psychologically and socially the patients did not differ appreciably from normals, and they exhibited a high degree of disease acceptance. This study, using a biopsychosocial approach in understanding sexual dysfunctions, is in contrast with previous, mainly uncontrolled, studies of epileptic patients that reported high frequencies of "hyposexuality" in males. We conclude that epilepsy does not necessarily increase the risk of sexual dysfunction in male or female.