El-Bahnasawy Magdy S, Osman Yasser, El-Hefnawy Ahmed, Hafez Afaf, Abdel-Latif Mohamed, Mosbah Ahmed, Ali-Eldin Bedir, Shaaban Atallah A
Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Scand J Urol Nephrol. 2011 Nov;45(5):332-8. doi: 10.3109/00365599.2011.585621. Epub 2011 Jun 21.
The aim of this study was to assess the impact of radical cystectomy and different forms of urinary diversion on female sexual function.
Seventy-three consecutive patients were included in the study. The mean age was 52.3 ± 6.5 years. All of them had undergone non-nerve-sparing radical cystectomy and urinary diversion for invasive bladder cancer. Patients were questioned about their current general relations with their husbands in comparison to the preoperative status. The Female Sexual Function Index (FSFI) was used to assess libido, lubrication, orgasm, satisfaction and painful sexual dysfunction. Patients were asked about any urinary complaints during or after sexual intercourse.
Twenty-nine patients (39%) reported worsening relations with their husbands. The mean frequency of sexual relations was 2.3 ± 2.3/month; however, sexual relations had ceased completely in 19 patients (26%). Overall satisfaction among sexually active women worsened in 32 (59.2%) and was completely lost in eight patients (14.8%). Absent libido, difficult intromission, dyspareunia, lack of orgasm and sexually related urinary complaints were reported in 89%, 63%, 48%, 63% and 63% of patients, respectively. The mean FSFI score dropped significantly from 18.3 ± 5.1 to 11.3 ± 7.4 postoperatively (p < 0.001). FSFI scores were significantly higher among patients with orthotopic versus non-orthotopic forms of diversion and also higher among patients with no stoma versus those with stomal forms of diversion.
Radical cystectomy and urinary diversion have deleterious impacts on all domains of female sexual function. Female patients with orthotopic and non-stomal diversions had better sexual functions than those with stomal diversions.
本研究旨在评估根治性膀胱切除术及不同形式的尿流改道对女性性功能的影响。
本研究纳入了73例连续患者。平均年龄为52.3±6.5岁。所有患者均因浸润性膀胱癌接受了非保留神经的根治性膀胱切除术及尿流改道。与术前状态相比，询问患者目前与丈夫的总体关系。采用女性性功能指数（FSFI）评估性欲、润滑、性高潮、满意度及疼痛性性功能障碍。询问患者性交期间或性交后有无任何泌尿系统不适。
29例患者（39%）报告与丈夫关系恶化。性关系的平均频率为2.3±2.3次/月；然而，19例患者（26%）的性关系已完全停止。有性生活的女性总体满意度在32例（59.2%）中恶化，8例患者（14.8%）完全丧失。分别有89%、63%、48%、63%和63%的患者报告存在性欲缺乏、插入困难、性交疼痛、性高潮缺失及与性相关的泌尿系统不适。术后FSFI平均评分从18.3±5.1显著降至11.3±7.4（p<0.001）。原位尿流改道患者的FSFI评分显著高于非原位尿流改道患者，无造口患者的FSFI评分也高于有造口尿流改道患者。
根治性膀胱切除术及尿流改道对女性性功能的所有方面均有有害影响。原位和无造口尿流改道的女性患者性功能优于有造口尿流改道的患者。
