Sexual function after male radical cystectomy in a sexually active population.
OBJECTIVE
To assess sexual dysfunction in sexually active men after radical cystectomy (RC) and to determine whether sildenafil citrate can improve erectile dysfunction after surgery.


METHODS
The baseline and follow-up data from 49 sexually active male patients (mean age 57.8 +/- 9.1 years) undergoing RC (1995 to 2002) were obtained. Of the 49 patients, 16 (33%) had undergone nerve-sparing RC; 38 (78%) had undergone orthotopic diversion; 8 (16%) had undergone ileal conduit diversion; and 3 (6%) had undergone cutaneous continent diversion. The data were assessed using the abridged 5-item International Index of Erectile Function questionnaire, referred to as the Sexual Health Inventory for Men (SHIM).


RESULTS
At a mean follow-up of 47.6 +/- 22.7 months, the total mean SHIM score decreased from 22.08 +/- 3.96 to 4.33 +/- 5.72 after RC (P <0.05). Of the 49 patients, 42 (86%) did not have erections sufficient for vaginal penetration. Of these 42 patients, 22 (52%) tried sildenafil citrate. Of these 22 patients, only 2 (9%) responded positively, with a total mean SHIM score of 23.50 +/- 2.12. Although the mean SHIM score after orthotopic substitution (5.24 +/- 6.21) was statistically significant compared with that after ileal conduit (1.13 +/- 0.33) and cutaneous continent (1.33 +/- 0.58) diversions, this was not clinically significant.


CONCLUSIONS
Male erectile dysfunction after RC is a prevalent problem. In our series, only 9 (14%) of 49 sexually active men were potent after surgery. Of these 9 potent patients, 8 (89%) had undergone nerve-sparing RC. Of concern, only 52% of the patients with erectile dysfunction sought treatment after RC.
Zippe
Craig D
CD
Center for Advanced Research in Human Reproduction, Infertility and Sexual Function, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Raina
Rupesh
R
Massanyi
Eric Z
EZ
Agarwal
Ashok
A
Jones
J Stephen
JS
Ulchaker
James
J
Klein
Eric A
EA
D000368:Aged; D002277:Carcinoma / Q000601:surgery; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology; D015653:Cystectomy / Q000009:adverse effects*; D003920:Diabetes Mellitus / Q000453:epidemiology; D004341:Drug Evaluation; D004351:Drug Resistance; D007172:Erectile Dysfunction / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D059348:Peripheral Nerve Injuries; D010879:Piperazines / Q000627:therapeutic use; D011687:Purines; D011788:Quality of Life; D000068677:Sildenafil Citrate; D018454:Spouses / Q000523:psychology; D013450:Sulfones; D011795:Surveys and Questionnaires; D001749:Urinary Bladder Neoplasms / Q000601:surgery; D014547:Urinary Diversion / Q000379:methods
D010879:Piperazines; D011687:Purines; D013450:Sulfones; D000068677:Sildenafil Citrate