Pronk Claudia E, Albers Leonore F, Kuijper Lothar D J, Hendricksen Kees, Nicolai Melianthe P J
Urology Department, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands.
Department of Urology, Leiden University Medical Centre, Leiden, The Netherlands; Department of Urology, Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Amsterdam, Netherlands.
Front Urol. 2023 Oct 3;3:1100516. doi: 10.3389/fruro.2023.1100516. eCollection 2023.
Little is known about the long-term effects on sexual function (SF) after radical cystectomy (RC) in bladder carcinoma (BC) patients.
To assess the course of SF in BC patients who underwent RC, and individual characteristics that influence the sexual outcome during a six-year follow-up.
In this longitudinal study, 62 BC patients treated with RC were included between 2008 and 2022. Patients filled out validated questionnaires as part of the regular care at baseline, three months, six months, 12 months and thereafter yearly post RC.
To determine the sexual function, the International Index of Erectile Function questionnaire was filled in and a linear mixed model for repeated measures was conducted. The analysed clinical variables included sexual preserving cystectomy (SPC), age, type of diversion, treatment, comorbidities, tumour status, smoking habits, patient status and open- or robot-assisted RC. A Generalised Linear Mixed Model was used to evaluate the impact on Quality of Life with the QLQ-C30 questionnaire.
After an initial decrease of sexual function post-RC, no change in SF was seen during the six years of follow-up. A statistically significant difference in sexual health was found between SPC and standard RC (p=0.015), which was time-dependent. Patients with an orthotopic ileal neobladder experienced a significantly better SF than those with a Bricker's ileal conduit (p=<0.001). A younger age also seemed to yield beneficial outcomes regarding SF (p=0.004). Other analysed clinical variables did not influence the course of SF. A statistically significant positive correlation was found between Quality of Life- and SF scores (p=0.004). Robot-assisted RC resulted in higher Global Health scores than open RC (p=0.001).
RC has a severe impact on sexual function. Although SPC, collinear with the use of an orthotopic ileal neobladder and younger patient age show better outcomes in SF, erectile dysfunction post-RC is moderate to severe in the vast majority of patients.
关于膀胱癌（BC）患者根治性膀胱切除术（RC）后对性功能（SF）的长期影响知之甚少。
评估接受RC的BC患者的性功能变化过程，以及在六年随访期间影响性功能结果的个体特征。
在这项纵向研究中，纳入了2008年至2022年间接受RC治疗的62例BC患者。患者在基线、术后三个月、六个月、12个月及之后每年作为常规护理的一部分填写经过验证的问卷。
为确定性功能，填写国际勃起功能指数问卷，并进行重复测量的线性混合模型分析。分析的临床变量包括保留性功能的膀胱切除术（SPC）、年龄、改道类型、治疗、合并症、肿瘤状态、吸烟习惯、患者状态以及开放或机器人辅助的RC。使用广义线性混合模型通过QLQ-C30问卷评估对生活质量的影响。
RC术后性功能最初下降后，在六年随访期间性功能未见变化。SPC和标准RC之间在性健康方面存在统计学显著差异（p=0.015），这是时间依赖性的。原位回肠新膀胱患者的性功能明显优于Bricker回肠导管患者（p<0.001）。较年轻的年龄在性功能方面似乎也产生有益结果（p=0.004）。其他分析的临床变量未影响性功能变化过程。生活质量得分与性功能得分之间存在统计学显著正相关（p=0.004）。机器人辅助RC导致的总体健康得分高于开放RC（p=0.001）。
RC对性功能有严重影响。尽管SPC、与使用原位回肠新膀胱相关以及较年轻的患者年龄在性功能方面显示出更好的结果，但绝大多数患者RC后的勃起功能障碍为中度至重度。
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