Bizzarri Francesco Pio, Campetella Marco, Recupero Salvatore Marco, Bellavia Fabrizio, D'Amico Lorenzo, Rossi Francesco, Gavi Filippo, Filomena Giovanni Battista, Russo Pierluigi, Palermo Giuseppe, Foschi Nazario, Totaro Angelo, Ragonese Mauro, Sighinolfi Maria Chiara, Racioppi Marco, Sacco Emilio, Rocco Bernardo
Department of Urology, Ospedale Isola Tiberina-Gemelli Isola, 00186 Rome, Italy.
Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli, 00168 Rome, Italy.
J Pers Med. 2025 Sep 2;15(9):415. doi: 10.3390/jpm15090415.
Sexuality in women with muscle-invasive bladder cancer (MIBC) undergoing radical treatment represents a crucial aspect of their overall quality of life, which is increasingly recognized as a key component of patient-centered care and long-term well-being. This review aimed to analyze the available literature to provide a comprehensive overview of the effects of treatments on female sexual function. We included all qualitative and quantitative studies addressing sexual function in patients treated for MIBC. Excluded were narrative reviews, case reports, conference abstracts, systematic reviews, and meta-analyses. The included studies involved women undergoing either robot-assisted radical cystectomy (RARC) or open RC (ORC), often with nerve-sparing, vaginal-sparing, or pelvic organ-preserving techniques. Data on oncological and functional outcomes were collected. A systematic review of 29 studies including 1755 women was conducted. RC was performed via robotic/laparoscopic approaches in 39% of cases and open techniques in 61%. Urinary diversions included orthotopic neobladders (48%), ileal conduits (42%), ureterocutaneostomies (3%), and Indiana pouches (7%). Radiotherapy, used in 6% of patients, was mainly applied in a curative, trimodal setting. Sexual function was evaluated using various pre- and/or postoperative questionnaires, most commonly the EORTC QLQ-C22, FACT-BL, Bladder Cancer Index (BCI), LENT SOMA, and Female Sexual Function Index (FSFI). Radiotherapy was associated with reduced sexual function, though outcomes were somewhat better than with surgery. Among surgical approaches, no differences in sexual outcomes were observed. Further qualitative research is essential to better understand the experience of FSD after treatment. Incorporating both patient and clinician perspectives will be key to developing tailored interventions. In addition, efforts should be made to standardize the questionnaires used to assess female sexual dysfunction, in order to improve comparability across studies and ensure consistent evaluation.
接受根治性治疗的肌层浸润性膀胱癌（MIBC）女性的性功能是其整体生活质量的一个关键方面，这一点越来越被视为以患者为中心的护理和长期健康的关键组成部分。本综述旨在分析现有文献，以全面概述治疗对女性性功能的影响。我们纳入了所有涉及接受MIBC治疗患者性功能的定性和定量研究。排除了叙述性综述、病例报告、会议摘要、系统评价和荟萃分析。纳入的研究涉及接受机器人辅助根治性膀胱切除术（RARC）或开放性根治性膀胱切除术（ORC）的女性，这些手术通常采用保留神经、保留阴道或保留盆腔器官的技术。收集了肿瘤学和功能结局的数据。对29项研究（包括1755名女性）进行了系统评价。39%的病例通过机器人/腹腔镜方法进行根治性膀胱切除术，61%采用开放技术。尿流改道包括原位新膀胱（48%）、回肠膀胱术（42%）、输尿管皮肤造口术（3%）和印第安纳袋（7%）。6%的患者使用了放疗，主要用于根治性三联治疗。使用各种术前和/或术后问卷评估性功能，最常用的是欧洲癌症研究与治疗组织QLQ-C22问卷、FACT-BL问卷、膀胱癌指数（BCI）、LENT SOMA问卷和女性性功能指数（FSFI）。放疗与性功能下降有关，尽管其结果比手术稍好。在手术方法中，未观察到性功能结局的差异。进一步的定性研究对于更好地了解治疗后性功能障碍的经历至关重要。将患者和临床医生的观点结合起来对于制定个性化干预措施至关重要。此外，应努力使用于评估女性性功能障碍的问卷标准化，以提高研究之间的可比性并确保评估的一致性。
