title: Restoration of sexual activity in patients with chronic hydrocephalus after shunt placement.
abstract: BACKGROUND
  Chronic (normotensive or low pressure) hydrocephalus is characterized clinically by gait disturbance, cognitive and urinary impairment, known as Hakim's triad. Nothing has been reported about impairment in sexual function, which could involve both the patient and the patient's partner.
  
  
  METHODS
  Out of 97 patients undergoing shunt placement for chronic hydrocephalus, 28 male patients (28.8%) referenced sexual dysfunction before operation. In these cases, we performed a preoperative and postoperative survey of sexual activity.
  
  
  RESULTS
  In the preoperative period, all 28 patients reported having no sexual activity or arousal, from 2 to 4 years before the operation. Following shunt placement, 22/28 (78.5%) of patients regained variable sexual desire within a period ranging from 3 to 8 weeks, affording normal sexual activity with their partner.
  
  
  CONCLUSIONS
  Sexual dysfunction can be part of the very early clinical background in patients with Hakim's triad and neuroradiological imaging compatible with chronic hydrocephalus. Restoration of sexual ability and arousal should be considered among the postoperative goals in these cases, together with improvements in cognition, gait, and urinary continence.
authors.affiliation: Department of Neuroscience, Neurosurgery, University of Rome Sapienza, Rome, Italy. missorp@yahoo.com
authors.forename: Paolo
authors.initials: P
authors.lastname: Missori
authors.forename: Antonio
authors.initials: A
authors.lastname: Scollato
authors.forename: Rita
authors.initials: R
authors.lastname: Formisano
authors.forename: Antonio
authors.initials: A
authors.lastname: Currà
authors.forename: Concetta
authors.initials: C
authors.lastname: Mina
authors.forename: Massimo
authors.initials: M
authors.lastname: Marianetti
authors.forename: Filippo Maria
authors.initials: FM
authors.lastname: Polli
authors.forename: Simone
authors.initials: S
authors.lastname: Peschillo
authors.forename: Sergio
authors.initials: S
authors.lastname: Paolini
authors.forename: Alessandro
authors.initials: A
authors.lastname: Frati
authors.forename: Massimo
authors.initials: M
authors.lastname: Miscusi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002557:Cerebrospinal Fluid Shunts; D003072:Cognition Disorders / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D007989:Libido / Q000502:physiology; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000295:instrumentation* / Q000379:methods; D017060:Patient Satisfaction; D011788:Quality of Life / Q000523:psychology; D020127:Recovery of Function / Q000502:physiology; D012725:Sexual Behavior / Q000502:physiology; D012735:Sexual Dysfunction, Physiological / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014555:Urination Disorders / Q000209:etiology / Q000503:physiopathology / Q000601:surgery