Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Comprehensive Cancer Center, Case Western Reserve School of Medicine, Cleveland, OH, USA.
Sex Med Rev. 2022 Apr;10(2):231-239. doi: 10.1016/j.sxmr.2021.10.005. Epub 2022 Jan 3.
A clear and well-documented gender bias exists in the evaluation of sexual outcomes for women undergoing urologic surgery. Due to the anatomic template of anterior exenteration, women are commonly left with side effects that include sexual dysfunction and the perpetuated effects of surgical menopause.
To present evaluation and treatment recommendations for female sexual dysfunction treatment and evaluation, in addition to surgical templates during radical cystectomy (RC).
This article reviews current literature regarding sexual function and RC with urinary diversion in female bladder cancer patients. Furthermore, this review will provide a review of techniques for organ and neurovascular preservation, along with novel vaginal reconstruction templates. Our review will further focus on emerging technology, including minimally invasive surgery and organ and nerve preservation, directed at preservation of female sexual function.
Clinically, studies have demonstrated that females who have undergone genitalia-sparing and neurovascular preservation during RC regained sexual activity earlier than patients undergoing traditional RC. If organ and nerve preservation is not feasible due to involvement of trigone or bladder neck, vaginal reconstruction can mitigate the sexual dysfunction that results from a loss of the anterior vagina during a standard RC.
Female sexual dysfunction is associated with high levels of patient distress and is best comanaged with a multidisciplinary treatment approach, including preoperative counseling, intraoperative nerve, and organ preservation, and postoperative interventions to mitigate sexual side effects. Davis L, Isali I, Prunty M, et al. Female Sexual Function Following Radical Cystectomy in Bladder Cancer. Sex Med Rev 2022;10:231-239.
在评估接受泌尿科手术的女性的性结果方面，存在明显且有据可查的性别偏见。由于前盆切除术的解剖模板，女性通常会出现性功能障碍和手术绝经的持续影响等副作用。
提出女性性功能障碍治疗和评估的评估和治疗建议，以及根治性膀胱切除术 (RC) 期间的手术模板。
本文回顾了有关女性膀胱癌患者 RC 伴尿流改道的性功能以及 RC 的当前文献。此外，本综述将回顾器官和神经血管保护的技术，以及新的阴道重建模板。我们的综述将进一步关注微创技术，包括微创技术和器官和神经保护，以保留女性的性功能。
临床上，研究表明，在 RC 中进行生殖器保留和神经血管保护的女性比接受传统 RC 的女性更早恢复性行为。如果由于三角区或膀胱颈部受累而无法进行器官和神经保护，则阴道重建可以减轻标准 RC 中前阴道丢失引起的性功能障碍。
女性性功能障碍与患者的高度痛苦有关，最好通过多学科治疗方法来管理，包括术前咨询、术中神经和器官保护以及术后干预措施来减轻性副作用。戴维斯 L、伊萨利 I、普伦蒂 M 等人。膀胱癌根治性膀胱切除术后的女性性功能。性医学评论 2022；10:231-239。
