Spinoit Anne-Françoise, Waterschoot Mieke, Sinatti Céline, Abbas Tariq, Callens Nina, Cools Martine, Hamid Rizwan, Hanna Moneer K, Joshi Pankaj, Misseri Rosalia, Salle Joao Luiz Pippi, Roth Joshua, Tack Lloyd J W, De Win Gunter
Department of Urology, Ghent University Hospital, Ghent, Belgium.
Pediatric Urology, Sidra Hospital, Doha, Qatar.
World J Urol. 2021 Apr;39(4):1013-1019. doi: 10.1007/s00345-020-03121-2. Epub 2020 Feb 17.
To review existing literature about fertility and sexuality of boys born with complex congenital genitourinary anomalies.
A Pubmed review was performed in December 2018 to identify the most relevant original manuscripts regarding male complex congenital conditions affecting the urogenital system in male patients including spina bifida (SB), bladder exstrophy-epispadias complex (BEEC) and hypospadias. A comprehensive review was drafted exploring sexual dysfunction from a medical, psychosexual, surgical and reproductive point of view during transition from childhood (or adolescence) to adulthood.
About 75% of men with SB have erectile dysfunction (ED) (Gamé et al. in Urology 67(3):566-570, 2006; Diamond et al. in 58(4):434-435, 1986). Most SB patients have impaired sexual development mainly due to diminished self-esteem, dependence on caregivers and lack of privacy (Blum et al. in Pediatrics 88(2):280-285, 1991). Men with BEEC have fewer intimate relationships than women because of the greater difficulties with issues regarding their genitalia and sexual activities (Deans et al. in Am J Obstet Gynecol 206(6):496.e1-496.e6, 2012). However, a good quality of life is achievable with the effective use of coping strategies (Deng et al. in Transl Androl Urol 7:941, 2018; Rikken et al. in BMC Womens Health 18(1):163, 2018; Friedler et al. in Reprod Biomed Online 32(1):54-61, 2016). Chordee occurs in 25% of all hypospadias patients. More severe hypospadias is related to a greater risk for complications. The long-term sexual quality of life (QoL) in men who underwent hypospadias surgery is influenced by a lot of factors. Therefore, an interactive and dynamic biopsychosocial model of sexual QoL was proposed.
The care of patients with congenital urologic conditions becomes a challenge especially in the period of 'transition'. The goal of follow-up is a holistic management viewed from a medical, psychosexual, surgical end reproductive point. All patients should be asked for specific urinary, fecal or sexual concerns.
回顾关于患有复杂先天性泌尿生殖系统异常的男孩的生育能力和性功能的现有文献。
2018年12月进行了一项PubMed综述，以确定与影响男性患者泌尿生殖系统的男性复杂先天性疾病最相关的原始手稿，这些疾病包括脊柱裂（SB）、膀胱外翻-尿道上裂复合体（BEEC）和尿道下裂。从医学、心理性、手术和生殖的角度，起草了一份关于从儿童期（或青春期）到成年期过渡期间性功能障碍的综合综述。
约75%的脊柱裂男性患者存在勃起功能障碍（ED）（加梅等人，《泌尿外科》，2006年，第67卷第3期，第566 - 570页；戴蒙德等人，1986年，第58卷第4期，第434 - 435页）。大多数脊柱裂患者的性发育受损，主要原因是自尊心下降、对照顾者的依赖以及缺乏隐私（布卢姆等人，《儿科学》，1991年，第88卷第2期，第280 - 285页）。由于在生殖器和性活动方面存在更大困难，膀胱外翻-尿道上裂复合体男性患者的亲密关系比女性少（迪恩斯等人，《美国妇产科杂志》，2012年，第206卷第6期，第496.e1 - 496.e6页）。然而，通过有效运用应对策略可以实现良好的生活质量（邓等人，《转化男科学与泌尿学》，2018年，第7卷，第941页；里肯等人，《BMC女性健康》，2018年，第18卷第1期，第163页；弗里德勒等人，《生殖生物医学在线》，2016年，第32卷第1期，第54 - 61页）。所有尿道下裂患者中有25%会出现阴茎下弯。更严重的尿道下裂与更高的并发症风险相关。接受尿道下裂手术的男性的长期性生活质量（QoL）受多种因素影响。因此，提出了一种关于性QoL的互动和动态生物心理社会模型。
先天性泌尿系统疾病患者的护理成为一项挑战，尤其是在“过渡”时期。随访的目标是从医学、心理性、手术和生殖角度进行全面管理。应询问所有患者关于排尿、排便或性方面的具体问题。
