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Sexual dysfunction after cystectomy and urinary diversion

Nature Reviews Urology volume 11, pages 445–453 (2014)Cite this article

Subjects

Key Points

  • Sexual dysfunction is a common, but often overlooked, consequence of radical cystectomy in both men and women

  • Sexual dysfunction after radical cystectomy results from a combination of iatrogenic, organic, and psychological factors

  • Health-related quality-of-life surveys specific to patients with bladder cancer have been developed in attempts to better understand the sources of sexual dysfunction

  • Treatment protocols must be tailored to the specific source of sexual dysfunction in each patient and often require both medical treatments and counselling

  • Surgical strategies such as nerve-sparing and vagina-sparing cystectomy might offer improved sexual outcomes while maintaining effective oncological control

Abstract

Erectile dysfunction (ED) in men and sexual dysfunction in men and women are common after cystectomy and urinary diversion. Research has focused on both qualifying the prevalence of ED following cystectomy and identifying surgical approaches to limit sexual dysfunction after surgery, but most studies have been limited by small patient populations, an absence of control groups, and a lack of adjustment for confounding factors. Similarly, quality of life (QoL) research studies have also emerged in the context of bladder cancer and cystectomy, and increase our understanding of sexual outcomes associated with cystectomy. A number of instruments for collection of patient-reported outcomes among patients with bladder cancer treated with cystectomy are available for the assessment of condition-specific and procedure-specific QoL. However, other factors that negatively affect sexual function after removal of the bladder, such as psychological issues, age, and health-related competing risks for ED, body image, partner response, and change in life course and sexual priorities, have received less attention. Nevertheless, ED and sexual dysfunction are important complications of cystectomy and urinary diversion. Although changes in the approach to surgery, such as nerve-sparing cystectomy, might improve outcomes, evaluation and management of the source factors of ED and sexual dysfunction are necessary to optimize recovery of function.

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Acknowledgements

S.M.G. acknowledges grant support from the NIH as co-investigator on a project led by Principle Investigator C. McMullen, entitled 'Urinary Diversion Among Bladder Cancer Survivors: Costs, Complications, and QOL' (grant: R01 CA164128-01A1).

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Authors and Affiliations

  1. Department of Urology, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, 32603, FL, USA

    Rishi A. Modh

  2. Department of Surgery, Male Sexual and Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, 10065, NY, USA

    John P. Mulhall

  3. Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, 33612, FL, USA

    Scott M. Gilbert

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R.A.M. and S.M.G. researched the data for the article, and all authors made substantial contributions to discussion of content and writing the manuscript. J.P.M. and S.M.G. reviewed/edited the manuscript before submission.

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Correspondence to Scott M. Gilbert.

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Modh, R., Mulhall, J. & Gilbert, S. Sexual dysfunction after cystectomy and urinary diversion. Nat Rev Urol 11, 445–453 (2014). https://doi.org/10.1038/nrurol.2014.151

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