Endourological procedures and sexual dysfunction: a prospective multivariate analysis.

OBJECTIVE: To investigate whether endourological interventions are associated with postoperative sexual dysfunction. PATIENTS AND METHODS: The study comprises a consecutive and prospective series of patients, referred for endourological procedures. General anaesthesia was used and JJ stents were placed when required. Changes in sexual function, as assessed by the International Index of Erectile Function questionnaire that the participants filled in the day before the procedure and 1 month and up to 3 months afterwards, were analysed. RESULTS: The study group consisted of 50 men aged (mean ± SD) 45 ± 13 years, of whom 25 underwent ureteroscopy, 9 underwent retrograde intrarenal surgery (RIRS) and 16 underwent combined RIRS and percutaneous nephrolithotomy. JJ stents were postoperatively placed in 33 patients (66%). The study cohort self-reported a significant decrease in erectile function (P= 0.007), intercourse satisfaction (P < 0.001), orgasmic function (P= 0.001), sexual desire (P < 0.001) and overall satisfaction (P= 0.002) at 1 month following endourological procedures. This dysfunction was not related to chronic disease, age, smoking, preoperative or postoperative stenting, type of procedure, operative duration or surgeon expertise. The sexual function of all subjects returned to baseline within 3 months (P < 0.005). Postoperative erectile function in the stented group revealed a negative tendency that did not reach statistical significance. CONCLUSIONS: Endourological procedures are associated with temporary postoperative sexual dysfunction, which completely recovers within 3 months. The impact of postoperative stenting on sexual function was not significant. These findings contribute to enhanced preoperative patient counselling.

Tubeless percutaneous nephrolithotomy: first 200 cases in Israel.

BACKGROUND: Tubeless percutaneous nephrolithotomy is defined as PCNL without postoperative nephrostomy tubes. It is reported to reduce postoperative pain, hospital stay and recovery time. To date the procedure has been reserved for selected patients. OBJECTIVES: To assess our initial experience in extending the implementation of tubeless PCNL without preoperative patient selection. METHODS: All consecutive PCNLs performed during 2004-2008 were evaluated. Tubeless PCNL was performed when residual stones, bleeding and extravasation were excluded intraoperatively. Staghorn stones, stone burden, supracostal and multiple accesses, anatomic anomalies, solitary kidneys and operative time were not considered contraindications. We analyzed the clinical data and the choice of tubeless PCNL over time. RESULTS: Of 281 PCNLs performed during the study period 200 (71%) were tubeless. The patients' average age was 53 years (range 28-82 years), the stone burden was 924 mm2 (400-3150 mm2), operative time was 99 minutes (45-210 min), complication rate was 14% and immediate stone-free rate 91%. There were 81 conversions to standard PCNL (29%) due to expected second-look (n = 47, 58%), impression of bleeding (n = 21,26%), suspected hydrothorax (n = 7, 9%) and extravasation (n = 6, 7%). The transfusion rate was 1%. The median hospital stay was 1 day (1-15 days) and recovery time 7 days (5-20 days). The rate of implementing the tubeless procedure increased steadily along time from 46% to 83% (P = 0.0001). CONCLUSIONS: Tubeless PCNL can be safely and effectively performed based on intraoperative decisions, without preoperative contraindications. They are easily accommodated by experienced endourologists and provide real advantages.