Presentation Authors: Saum Ghodoussipour*, Jullet Han, Nima Nassiri, Paul Oh, Ryan Atkinson, Hooman Djaladat, Anne Schuckman, Sumeet Bhanvadia, Siamak Daneshmand, Jeffrey Loh-Doyle, Los Angeles, CA
Introduction: Sexual dysfunction after radical cystectomy (RC) is poorly characterized and under treated. Herein, we prospectively evaluate sexual health outcomes in male patients undergoing RC using a self-reported patient questionnaire.
Methods: After IRB approval, patients with history of RC were asked to complete a questionnaire addressing sexual health outcomes during regular follow-up appointments. The questionnaire included the Sexual Health Inventory for Men (SHIM) as well as several supplemental questions addressing libido, medications used to assist in erections, penile prostheses (PP) adequacy of preoperative counseling, and interest in maintaining/restoring sexual function.
Results: From October 2017 to October 2018, 130 patients completed the questionnaire. Median age at RC was 68 years with median follow-up of 27 months (IQR 12-66 months). A preop SHIM was available in 41 patients, with median score 14 (IQR 3-22). Nerve sparing (NS) was performed in 51 (39%) patients who had a median preop SHIM of 22 (IQR 17.5-24). _x000D_
At the time of follow-up, median SHIM for patients without NS was 1 (IQR 1-15). On a scale of 1-5, with 1 being very low and 5 being very high, the median postop rating of libido (defined as interest in sex or masturbation) was 3 (moderate)(IQR 1-3). Medications to assist with erections were used in 40 (30.8%) patients with success in 16 (40%). A PP was placed in 27 (21%) patients. _x000D_
Patients with NS had a greater median postop SHIM (6 vs 1), libido (3 vs 2), and ability to orgasm (53 vs 33%) (all p < 0.05) compared to those without NS. A similar trend was seen in patients with PP versus those without PP. (19 vs 1, 3 vs 2, and 85 vs 31% for SHIM, libido and ability to orgasm respectively, all p < 0.05). _x000D_
On univariate analysis, a younger age at follow up, NS, placement of PP, orthotopic diversion, and absence of comorbidities or smoking were all associated with a higher postop SHIM, libido, and retained ability to orgasm (all p < 0.05). However, on multivariate linear regression, only age at follow up < 71 years (b=-0.29, p < 0.01,) and lack of PP (b=-9.5, p < 0.01) remained correlated with post op SHIM. _x000D_
Only 50 (38.5%) patients reported sufficient counseling before surgery while 79 (60.8%) reported interest in maintaining or restoring function at follow-up.
Conclusions: Sexual dysfunction after RC is prevalent. While NP and insertion of PP can improve erectile function and libido after RC, a significant proportion of patients will experience sexual dissatisfaction. Our study suggests that discussing and treating sexual dysfunction with patients before and after surgery should be prioritized.