Hybrid Transvaginal NOTES Nephrectomy: Postoperative Sexual Outcomes. A Three-center Matched Study.
OBJECTIVE
To evaluate our experience in patients undergoing hybrid transvaginal natural orifices transluminal endoscopic surgery (NOTES) nephrectomy and evaluate the sexual functions in the postoperative period.


METHODS
Prospective data of 71 patients with renal tumors who underwent hybrid NOTES radical nephrectomy in three different centers were collected from March 2010 to October 2015. Patient and surgical characteristics were recorded. Sexual function was evaluated using the Female Sexual Function Index questionnaire the day prior to the operation and 3 months after.


RESULTS
The mean age, tumor size, and operation duration were 66.16 ± 11.21, 8.51 ± 3.31 cm, and 119.94 ± 21.38 minutes, respectively. Five patients were immediately reoperated due to bleeding from uterine veins. The complication risk increases significantly with increasing tumor size. Among the whole cohort, even the Female Sexual Function Index score differences are small; there is a statistically significant decrease in the postoperative period in all domains except sexual satisfaction. In fact, the patients reported unaltered sexual function after surgery and satisfaction with the result when asked directly. In subgroup analyses, in nulliparous patients (n = 60), arousal, sexual desire, orgasm, and satisfaction domains have no significant differences in pre- and postoperative periods.


CONCLUSIONS
Hybrid NOTES nephrectomy is a feasible, safe operation that can be performed for large renal tumors. Due to incisions in the vaginal wall for specimen retrieval, sexual function can be altered in the postoperative period. So patient selection, preoperative evaluation, and close follow-up are mandatory. With this in mind, we strongly support the use of hybrid transvaginal NOTES nephrectomy for large renal tumors especially in nulliparous patients.
Department of Human Pathology-Section of Urology, University of Messina, Messina, Italy.
Salvatore
S
Butticè
Department of Urology, School of Medicine, Marmara University, Istanbul, Turkey. Electronic address: dr.emresener@gmail.com.
Tarik Emre
TE
Sener
Clinical Institute of Urology and Renal Transplant, Cluj-Napoca, Romania.
Valerian Ciprian
VC
Lucan
Department of Urology, Tenon University Hospital, Pierre and Marie Curie University, Paris, France.
Luca
L
Lunelli
Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy.
Antonio Simone
AS
Laganà
Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy.
Salvatore Giovanni
SG
Vitale
Department of Urology, Asklepios Hospital Barmbek, Hamburg, Germany.
Christopher
C
Netsch
Department of Urology, School of Medicine, Marmara University, Istanbul, Turkey.
Yiloren
Y
Tanidir
Department of Human Pathology-Section of Urology, University of Messina, Messina, Italy.
Rosa
R
Pappalardo
Department of Human Pathology-Section of Urology, University of Messina, Messina, Italy.
Carlo
C
Magno
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D009392:Nephrectomy / Q000379:methods*; D017060:Patient Satisfaction; D011184:Postoperative Period; D011446:Prospective Studies; D012725:Sexual Behavior / Q000502:physiology*; D019529:Sexuality / Q000502:physiology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014621:Vagina