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男性患者行开放性根治性膀胱切除术和尿流改道术后的患者报告性功能结局。

Patient Reported Sexual Function Outcomes in Male Patients Following Open Radical Cystoprostatectomy and Urinary Diversion.

机构信息

Department of Urology, USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA.

Department of Urology, USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA.

出版信息

Urology. 2021 Nov;157:161-167. doi: 10.1016/j.urology.2021.07.004. Epub 2021 Jul 21.

DOI:10.1016/j.urology.2021.07.004
PMID:34298032
Abstract

OBJECTIVE

To report sexual health outcomes in male patients undergoing open radical cystoprostatectomy using a validated questionnaire.

MATERIALS AND METHODS

Beginning in 2017, male patients were asked to complete a validated questionnaire during scheduled post-cystectomy clinic visits that assessed sexual function using the 5 item International Index of Erectile Function (IIEF-5) and supplemental questions which evaluated libido, orgasm, partner interest, and adequacy of pre-operative counselling. Baseline data and functional outcomes were compared and multivariable analysis performed.

RESULTS

A total of 134 patients who met inclusion criteria completed the questionnaire. Pre-operative IIEF-5 was available in 78 patients with a median score of 16 (IQR:5-23). In those patients, median age at cystectomy was 68.9 years (IQR:60.2-72.4) and median duration of follow-up was 17.3 months (IQR:6.3-28.7). Median IIEF-5 score at time of survey completion was 1 (IQR:1-11). Increasing age, shorter follow-up duration, insufficient counselling, and absence of partner interest were predictive of lower scores. Younger age, pre-operative erectile function, and neurovascular preservation were predictive of a higher IIEF-5 score on univariate and multivariate analysis. Median libido score was 2 "low" (IQR:1-3) and ability to orgasm was reported by 34 (43.6%) patients. Neurovascular preservation (OR:3.03 95% CI:1.10-8.26, P = .03) and sufficient preoperative counselling (OR:3.078 95% CI:1.17-8.098, P = .02) were associated with preserved ability to orgasm. Libido was influenced by partner interest (OR 11.7, 95% CI:3.793-6.14, P <.0001).

CONCLUSION

Sexual dysfunction after radical cystoprostatectomy is prevalent with many contributing factors. As such, establishing appropriate expectations and goals during preoperative counseling, performing neurovascular preservation when appropriate, and readily identifying and treating dysfunction in follow-up may improve sexual recovery.

摘要

目的

使用经过验证的问卷报告接受开放式根治性膀胱切除术的男性患者的性健康结果。

材料与方法

自 2017 年开始,在 scheduled post-cystectomy 临床就诊期间,要求男性患者使用经过验证的问卷完成性功能评估,该问卷使用 5 项国际勃起功能指数(IIEF-5)和补充问题评估性欲、勃起、伴侣兴趣和术前咨询的充分性。比较基线数据和功能结果,并进行多变量分析。

结果

共有 134 名符合纳入标准的患者完成了问卷。78 名患者可获得术前 IIEF-5,中位数为 16(IQR:5-23)。在这些患者中,膀胱切除术时的中位年龄为 68.9 岁(IQR:60.2-72.4),中位随访时间为 17.3 个月(IQR:6.3-28.7)。调查完成时的中位 IIEF-5 评分为 1(IQR:1-11)。年龄增长、随访时间缩短、咨询不足和缺乏伴侣兴趣与较低的评分相关。年龄较轻、术前勃起功能和神经血管保护与单变量和多变量分析中更高的 IIEF-5 评分相关。中位性欲评分为 2“低”(IQR:1-3),34 名(43.6%)患者能够勃起。神经血管保护(OR:3.03 95%CI:1.10-8.26,P=0.03)和充分的术前咨询(OR:3.078 95%CI:1.17-8.098,P=0.02)与保持勃起能力相关。性欲受伴侣兴趣影响(OR 11.7,95%CI:3.793-6.14,P<0.0001)。

结论

根治性膀胱切除术后性功能障碍很常见,有许多相关因素。因此,在术前咨询中建立适当的期望和目标,在适当的情况下进行神经血管保护,并在随访中及时识别和治疗功能障碍,可能会改善性功能恢复。

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