Surgical Factors Associated With Male and Female Sexual Dysfunction After Radical Cystectomy: What Do We Know and How Can We Improve Outcomes?

Background: Sexual dysfunction after radical cystectomy (RC) is a frequent, though commonly overlooked symptom for both men and women. Improved oncological outcomes and the rising number of bladder cancer survivors mandate physicians to closely address and evaluate post-surgical sexual dysfunction and offer goal-directed treatment. Improvements in RC surgical techniques that promote post-operative sexual function have been proposed, alongside new quality-of-life inventories and sexual function therapeutic options; however, rigorous studies in the field are lacking. Aim: To provide a comprehensive overview of post-RC sexual dysfunction and discuss new surgical techniques, sexual dysfunction evaluation, and novel treatment strategies. Methods: A non-systematic narrative review of the literature was performed through PubMed about sexual dysfunction in men and women after RC. Outcomes: We reported on the surgical anatomy of sexual function-sparing RC, the most common inventories used to investigate sexual function in post-RC patients, and current treatment options. Results: Extensive knowledge about pelvic anatomy and nerve-sparing surgical techniques in men is well understood from studies about prostate anatomy and nerve-sparing prostatectomy. However, anatomical and surgical details of sexual-sparing RC in women needs further characterization. Several questionnaires are used to investigate sexuality after RC, but a standardized approach is still missing. Therapeutic options are available to treat sexual dysfunction, but limited studies have been conducted to specifically address the post-RC population. Conclusion: Further work is needed to understand the best strategies to prevent and treat sexual dysfunction in patients after RC. Pederzoli F, Campbell JD, Matsui H, et al. Surgical Factors Associated With Male and Female Sexual Dysfunction After Radical Cystectomy: What Do We Know and How Can We Improve Outcomes? Sex Med Rev 2018;6:469–481.