Prospective evaluation of early postoperative male and female sexual function after radical prostatectomy with erectile nerves preservation.

Prostate cancer screening has led to the diagnosis of localized prostate cancer in increasingly young and sexually active men. Accordingly, the impact of cancer treatment on sexual function is gaining more attention. To prospectively evaluate the impact of radical prostatectomy (RP) on male, female and conjugal sexual function. Patients were prospectively assessed by an urologist and a sexologist before and 6 months after robot-assisted laparoscopic RP (RALP). RALP was performed with uni- or bilateral neurovascular bundle preservation by a single surgeon. Postoperatively, all patients were prescribed tadalafil 20 mg, 3 times a week during 6 months. Male and female sexual functions were evaluated by using the International Index of Erectile Function (IIEF-5), the Female Sexual Function Index (FSFI) and the Lock-Wallace Marital Adjustment Test (MAT). Continuous variables were analyzed with rank-sum and t-tests, as needed, and categorical variables with chi-squared tests. All tests were two-sided, with a P-value ⩽ 0.05 considered significant. Twenty-one couples were included. Mean patient male and female age was 62.4 and 60.7 years, respectively. Bilateral nerve sparing was performed in 12/21 (57%) patients. Median preoperative IIEF-5 was 20/25, corresponding to mild erectile dysfunction (ED). Median preoperative FSFI and MAT were both within normal range (28/36 and 114/158, respectively). Six months following surgery, both IIEF-5 (11/25) and FSFI (25/36) had significantly dropped (P=0.007 and 0.003, respectively). Postoperative decreases in IIEF-5 and FSFI scores were associated within couples. MAT scores (115/158), however, remained unaffected by RALP, showing an unmodified relationship satisfaction postoperatively. Finally, bilateral nerve sparing surgery preserved not only male but also female sexual function. This study shows that the expected short-term post-RALP ED is associated with a worsening of female sexual function, whereas nerve sparing surgery has a protective effect on both the patient's and his partner's sexual function with a significant effect of bilateral over unilateral neurovascular bundle preservation. Furthermore, we found that conjugal complicity remains stable throughout the first semestrial postoperative period despite the decrease in sexual function.

[Treatment specificity of age-related sexual dysfunction]. / Troubles sexuels liés à lâge: quelles spécificités dans la prise en charge?

Despite an increase in life expectancy and ever growing demands for treatment aimed at age-related sexual dysfunction, it remains underdiagnosed among the elderly because of lack of information. Proper evaluation is critical because treatment is available and such a dysfunction often acts as a signal for an underlying pathology. This paper intends to clarify treatment specificity. Hormonal deficiencies, such as Symptomatic Late-Onset Hypogonadism (SLOH) should be treated using an interdisciplinary approach. For women, hormonal deficiency is not the unique cause of sexual dysfunction. Psychosocial factors also play an important role. Sexual dysfunction should be considered as an indicator of general health. Screening for hormonal deficiency should be systematic.

[Sexual function after radical prostatectomy: update of 2009]. / Fonction sexuelle après prostatectomie radicale: revue et prise en charge en 2009.

Prostate cancer is more frequently diagnosed in young males. It is then of utmost importance to improve preservation and recovery of sexual function. The surgical technique of radical prostatectomy has evolved and erectile nerve sparing allows now to achieve recovery in an important proportion of selected patients. However, rehabilitation and sexual counselling protocols are rare and may not include the partner. This has led us to propose a specific urologic and sexologic associated management.