Sexual function after radical cystectomy in males with bladder carcinoma: a six-year longitudinal single-centre study

Area of Science:

• Urology
• Oncology
• Sexual Medicine

Background:

• Radical cystectomy (RC) is a standard treatment for bladder carcinoma (BC).
• Long-term effects of RC on sexual function (SF) remain poorly understood.
• Assessing factors influencing sexual outcomes post-RC is crucial for patient care.

Purpose of the Study:

• To evaluate the long-term course of sexual function (SF) in bladder cancer (BC) patients following radical cystectomy (RC).
• To identify individual characteristics influencing sexual outcomes during a six-year follow-up period.

Main Methods:

• A longitudinal study including 62 BC patients treated with RC between 2008 and 2022.
• Validated questionnaires, including the International Index of Erectile Function (IIEF), were administered at baseline and at regular intervals up to six years post-RC.
• Linear mixed models and Generalized Linear Mixed Models were used to analyze SF, Quality of Life (QoL), and influencing clinical variables.

Main Results:

• Sexual function (SF) initially decreased post-RC but stabilized over the six-year follow-up.
• Sexual-sparing cystectomy (SSC), orthotopic ileal neobladder, and younger age were associated with significantly better SF outcomes.
• Robot-assisted RC showed higher Global Health scores compared to open RC, and a positive correlation was observed between QoL and SF.

Conclusions:

• Radical cystectomy (RC) has a significant negative impact on sexual function (SF) in bladder cancer (BC) patients.
• While SSC, orthotopic neobladder, and younger age offer improved SF, moderate to severe erectile dysfunction is prevalent post-RC.
• Quality of life is positively correlated with sexual function, highlighting the importance of preserving sexual health in BC survivors.