China Medical University, Shenyang, China.
Department of Urology, Liao Yang Liao Hua Hospital.
Sex Med Rev. 2024 Sep 25;12(4):600-610. doi: 10.1093/sxmrev/qeae051.
Bladder cancer ranks 17th in prevalence of cancer types among women, and the trend is rising. The increased risk of female sexual dysfunction (FSD) after radical cystectomy (RC) underscores the need for greater focus on preserving and mitigating FSD.
To place greater emphasis on the importance of female sexual function (FSF) in the treatment of bladder cancer and stimulate additional research to discover more effective solutions for enhancing the overall quality of life.
This review used a narrative approach. Previous reviews on FSF after RC have provided limited and 1-sided solutions due to the lack of research. What makes this review unique is its innovative approach: it includes all available measures curing FSD as well as comparative analyses based on experimental data, thus making the findings more comprehensive. A detailed perspective of treatments for female bladder cancer is provided, including nerve- and organ-sparing RC, robot-assisted RC, and radiotherapy. We also analyze the impact of treatments for female bladder cancer on postoperative FSD. Additionally, solutions for addressing or alleviating postoperative FSD are summarized, such as urinary diversion, vaginal reconstruction, and drug and nondrug treatment.
Research has suggested that robot-assisted nerve- and organ-sparing RC is promising. Moreover, orthotopic neobladder among urinary diversions without a stoma helps to maintain a positive female body image. If part of the anterior vaginal wall must be removed during RC, vaginal reconstruction can restore the dimensions with synthetic grafts and biologic scaffolds. Additionally, postoperative measures, such as vaginal laser and hormone therapy, and use of vaginal dilators and lubricants have a significant role in reducing distress caused by FSD to provide maximum relief.
To support FSF after RC, various interventions are needed, and urologists must focus on patient recovery while minimizing treatment impact on FSF as much as possible.
膀胱癌在女性癌症类型中排名第 17 位，且呈上升趋势。根治性膀胱切除术（RC）后女性性功能障碍（FSD）的风险增加，这凸显了需要更加关注保留和减轻 FSD。
强调在膀胱癌治疗中重视女性性功能（FSF）的重要性，并激发更多研究以发现更多增强整体生活质量的有效解决方案。
本综述采用叙述性方法。由于缺乏研究，之前关于 RC 后 FSF 的综述提供了有限且片面的解决方案。使本综述具有创新性的是，它纳入了所有可治疗 FSD 的措施，并基于实验数据进行了比较分析，从而使研究结果更加全面。提供了女性膀胱癌治疗的详细视角，包括保留神经和器官的 RC、机器人辅助 RC 和放疗。我们还分析了女性膀胱癌治疗对术后 FSD 的影响。此外，还总结了解决或缓解术后 FSD 的方法，如尿流改道、阴道重建以及药物和非药物治疗。
研究表明，机器人辅助保留神经和器官的 RC 有很大的潜力。此外，尿路分流术中的原位新膀胱没有造口，有助于保持女性的积极身体形象。如果在 RC 过程中必须切除部分前阴道壁，阴道重建可以用合成移植物和生物支架恢复尺寸。此外，术后措施，如阴道激光和激素治疗，以及使用阴道扩张器和润滑剂，在减轻 FSD 引起的痛苦方面发挥了重要作用，以提供最大的缓解。
为了支持 RC 后的 FSF，需要各种干预措施，泌尿科医生必须在关注患者康复的同时，尽可能减少治疗对 FSF 的影响。
