title: Perioperative outcome and female sexual function after laparoscopic transvaginal NOTES-assisted nephrectomy.
abstract: OBJECTIVE
  There is a concern about the impact that this surgery could have on a patient's sexuality, although this has not been well documented. The objective of our study is to describe the surgical results and assess sexual function and patient satisfaction after transvaginal NOTES-assisted laparoscopic radical and living donor nephrectomy.
  
  
  METHODS
  Between March 2008 and October 2014, 100 women underwent transvaginal NOTES-assisted nephrectomy (78 living donor and 22 radical nephrectomy) in our centre. The procedure was performed using two different techniques depending on the indication as described previously, but using the same vaginal approach. Variables evaluated were operative time, blood loss, intra-operative complications, hospital stay, satisfaction, first-month creatinine and warm ischaemia time in donors. Sexual function was assessed with the Female Sexual Function Index questionnaire before and after surgery. All variables were accrued in a prospective database.
  
  
  RESULTS
  The procedure was completed in all cases. Mean age and body mass index was higher in the radical nephrectomy group. Mean operative time and hospital stay were similar for both techniques. All sexually active women reported unaltered sexual function after surgery and satisfaction with the results. The pre- and post-FSFI scores for living donor (n = 54) and radical nephrectomy (n = 4) were 27.47 ± 1.02/27.27 ± 1.10 (p > 0.05) and 31.17 ± 0.81/31.87 ± 0.97 (p > 0.05).
  
  
  CONCLUSIONS
  Transvaginal NOTES-assisted or hybrid NOTES nephrectomy offers a safe technique with excellent cosmetic results and no sexual effect. Despite promising results, randomized controlled studies with longer follow-up are warranted to further elucidate the potential of this novel technique.
authors.affiliation: Department of Urology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Universitat de Barcelona (UB), C/Villarroel 170, 08036, Barcelona, Spain. lperi@clinic.ub.es.
authors.forename: Lluis
authors.initials: L
authors.lastname: Peri
authors.affiliation: Department of Urology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Universitat de Barcelona (UB), C/Villarroel 170, 08036, Barcelona, Spain.
authors.forename: Mireia
authors.initials: M
authors.lastname: Musquera
authors.affiliation: Department of Urology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Universitat de Barcelona (UB), C/Villarroel 170, 08036, Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Vilaseca
authors.affiliation: Department of Urology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Universitat de Barcelona (UB), C/Villarroel 170, 08036, Barcelona, Spain.
authors.forename: Eduard
authors.initials: E
authors.lastname: Garcia-Cruz
authors.affiliation: Department of Urology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Universitat de Barcelona (UB), C/Villarroel 170, 08036, Barcelona, Spain.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Ribal
authors.affiliation: Department of Urology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Universitat de Barcelona (UB), C/Villarroel 170, 08036, Barcelona, Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Carrión
authors.affiliation: Department of Urology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Universitat de Barcelona (UB), C/Villarroel 170, 08036, Barcelona, Spain.
authors.forename: Roberto
authors.initials: R
authors.lastname: Castañeda
authors.affiliation: Department of Urology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Universitat de Barcelona (UB), C/Villarroel 170, 08036, Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Alcaraz
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D007902:Length of Stay; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery; D009392:Nephrectomy; D061646:Operative Time; D017060:Patient Satisfaction; D012737:Sex Factors; D019529:Sexuality; D016896:Treatment Outcome
keywords: FSFI; NOTES; Nephrectomy; Sexual function; Transvaginal