title: Sexual function after male radical cystectomy in a sexually active population.
abstract: 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.
authors.affiliation: Center for Advanced Research in Human Reproduction, Infertility and Sexual Function, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Craig D
authors.initials: CD
authors.lastname: Zippe
authors.forename: Rupesh
authors.initials: R
authors.lastname: Raina
authors.forename: Eric Z
authors.initials: EZ
authors.lastname: Massanyi
authors.forename: Ashok
authors.initials: A
authors.lastname: Agarwal
authors.forename: J Stephen
authors.initials: JS
authors.lastname: Jones
authors.forename: James
authors.initials: J
authors.lastname: Ulchaker
authors.forename: Eric A
authors.initials: EA
authors.lastname: Klein
mesh_terms: 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
chemical_list: D010879:Piperazines; D011687:Purines; D013450:Sulfones; D000068677:Sildenafil Citrate