Modh Rishi A, Mulhall John P, Gilbert Scott M
Department of Urology, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL 32603, USA.
Male Sexual and Reproductive Medicine Program, Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
Nat Rev Urol. 2014 Aug;11(8):445-53. doi: 10.1038/nrurol.2014.151. Epub 2014 Jul 1.
Erectile dysfunction (ED) in men and sexual dysfunction in men and women are common after cystectomy and urinary diversion. Research has focused on both qualifying the prevalence of ED following cystectomy and identifying surgical approaches to limit sexual dysfunction after surgery, but most studies have been limited by small patient populations, an absence of control groups, and a lack of adjustment for confounding factors. Similarly, quality of life (QoL) research studies have also emerged in the context of bladder cancer and cystectomy, and increase our understanding of sexual outcomes associated with cystectomy. A number of instruments for collection of patient-reported outcomes among patients with bladder cancer treated with cystectomy are available for the assessment of condition-specific and procedure-specific QoL. However, other factors that negatively affect sexual function after removal of the bladder, such as psychological issues, age, and health-related competing risks for ED, body image, partner response, and change in life course and sexual priorities, have received less attention. Nevertheless, ED and sexual dysfunction are important complications of cystectomy and urinary diversion. Although changes in the approach to surgery, such as nerve-sparing cystectomy, might improve outcomes, evaluation and management of the source factors of ED and sexual dysfunction are necessary to optimize recovery of function.
男性勃起功能障碍（ED）以及男性和女性的性功能障碍在膀胱切除术后及尿流改道后很常见。研究主要集中在确定膀胱切除术后ED的患病率以及确定限制术后性功能障碍的手术方法，但大多数研究受到患者数量少、缺乏对照组以及未对混杂因素进行调整的限制。同样，生活质量（QoL）研究也出现在膀胱癌和膀胱切除术的背景下，并增进了我们对与膀胱切除术相关的性结局的理解。有多种用于收集接受膀胱切除术治疗的膀胱癌患者自我报告结局的工具，可用于评估特定疾病和特定手术的生活质量。然而，其他对膀胱切除术后性功能有负面影响的因素，如心理问题、年龄、与健康相关的ED竞争风险、身体形象、伴侣反应以及生活轨迹和性优先事项的变化，受到的关注较少。尽管如此，ED和性功能障碍是膀胱切除术和尿流改道的重要重要并发症。虽然手术方式的改变，如保留神经的膀胱切除术，可能会改善结局，但对ED和性功能障碍的源头因素进行评估和管理对于优化功能恢复是必要的。
