Identifying the Need to Discuss Infertility Concerns Affecting Testicular Cancer Patients: An Evaluation (INDICATE Study).

Men with testicular cancer (TC) risk impaired fertility. Fertility is a major concern for TC patients due to diagnosis in almost always reproductive ages and high overall survival. This study assessed counselling in regards to the risk of impaired fertility and sperm cryopreservation. A cross-sectional survey was performed on 566 TC patients diagnosed between 1995-2015. Of the 566 survivors, 201 questionnaires were completed (35.5%). Eighty-eight percent was informed about possible impaired fertility, 9.5% was not informed. The majority (47.3%) preferred the urologist to provide information. Collecting sperm was troublesome but successful for 25.6%, 4.8% did not succeed in collecting sperm. The reasons were high pressure due to disease, pain after surgery and uncomfortable setting. Due to impaired fertility, 19% of the respondents reported grief and 9.3% stated as being less satisfied in life. Sperm cryopreservation was performed by 41.3% (n = 83). One third (n = 63, 31.3%) had children after treatment, of which 11.1% made use of preserved sperm (n = 7). The results of this survey indicate the importance of timely discussion of fertility issues with TC patients. While being discussed with most men, dissatisfaction and grief may occur as a result of impaired fertility and a lack of counselling. Overall, 6.5% made use of cryopreserved sperm (n = 13). Men prefer their urologist providing counselling on fertility.

Discrepancy between Expectations and Experiences after Prostate Cancer Treatment: A Dutch Multicenter Study.

OBJECTIVES: To evaluate possible discrepancies between patients' expectations concerning sexual side effects related to prostate cancer treatment, based on the obtained information prior to treatment. Moreover, to determine if demographic or clinical factors may have an effect on the accuracy of patients' expectations concerning sexual side effects after treatment. METHODS: A multicenter, cross-sectional survey was performed among men treated with prostatectomy, brachytherapy, external-beam radiotherapy and/or hormonal therapy. RESULTS: In total, 412 questionnaires were analyzed. Of men with sexual side effects after treatment, 1 in 3 (32.5%, n = 109) reported their complaints as worse than expected; significantly more often reported by men treated surgically (P = .001), men with a local stage tumor (P = .005) and by men with a lower prostate-specific antigen level at diagnosis (P = .046). It was significantly less often reported by men treated with radiotherapy combined with hormonal therapy (P = .031). Men who used brochures as an information source reported their sexual side effects significantly less often as worse than expected (P < .001). CONCLUSION: One in three men with sexual side effects after prostate cancer treatment, experienced their complaints as worse than expected based on the obtained information prior to treatment. Men treated with radiotherapy combined with hormonal therapy indicated less discrepancy between expectations and developed sexual side effects, whereas prostatectomy, low stage tumor and low prostate-specific antigen level were associated with more discrepancy. Brochures should be administered additionally to verbal information to improve patients' understanding of possible sexual side effects and to enhance the accuracy of patients' expectations.

Discussing sexuality in the field of plastic and reconstructive surgery: a national survey of current practice in the Netherlands.

BACKGROUND: Patient-reported outcomes have become increasingly important to assess the value of surgical procedures. Sexual function is a proven important constituent of quality of life, but is often overlooked by health care professionals. We aim to investigate to what extent plastic surgeons address or discuss issues concerning sexuality with their patients, and if there is a need for improvement. METHODS: We developed a survey to assess whether topics pertaining to sexual function were discussed during plastic surgical consultations. In 2016, all 385 members of the Dutch Association for Plastic Surgery were invited via post mail to participate. RESULTS: We received 106 completed surveys (27.5%). The median age of the respondents was 45 (29-66) years. Most participants (78.3%) indicated that they rarely to never discuss sexuality with their patients. Surgeons in the subspecialization gender and genital surgery discussed sexual function most frequently. Two thirds of all respondents indicated that their current knowledge on this topic was insufficient, yet there was generally no interest expressed in receiving additional training (78.6%). However, there was a need for proper patient brochures (43.4%) and an organized referral network (36.5%) regarding sexuality. CONCLUSIONS: In plastic surgery practice, sexuality appears to be a rarely discussed subject, with the gender and genital surgery subspecialties as the exception. Although professionals and patients emphasize the importance of sexuality, plastic surgeons express limited urge to be trained and prefer written patient information and referring patients to other healthcare professionals. The authors stimulate more education on sexuality during (continued) plastic surgery training.Level of Evidence: Not ratable.

Suitable sexual health care according to men with prostate cancer and their partners.

PURPOSE: To determine which health care provider and what timing is considered most suitable to discuss sexual and relational changes after prostate cancer treatment according to the point of view of men and their partners. METHODS: A cross-sectional survey was conducted among men diagnosed with prostate cancer or treated after active surveillance, who received laparoscopic radical prostatectomy, brachytherapy, intensity-modulated radiotherapy, and/or hormonal therapy. If applicable, partners were included as well. RESULTS: In this survey, 253 men and 174 partners participated. Mean age of participating men was 69.3 years (SD 6.9, range 45-89). The majority (77.8%) was married and average length of relationship was 40.3 years (SD 14.1, range 2-64). Out of 250 men, 80.5% suffered from moderate to severe erectile dysfunction. Half of them (50.2%, n = 101) was treated for erectile dysfunction and great part was partially (30.7%, n = 31) up to not satisfied (25.7%, n = 26). Half of the partners (50.6%, n = 81) found it difficult to cope with sexual changes. A standard consultation with a urologist-sexologist to discuss altered sexuality is considered preferable by 74.7% (n = 183). Three months after treatment was the most suitable timing according to 47.6% (n = 49). CONCLUSIONS: During follow-up consultations, little attention is paid to the impact of treatment-induced sexual dysfunction on the relationship of men with prostate cancer and their partners. A standard consultation with a urologist-sexologist 3 months after treatment to discuss sexual and relational issues is considered as most preferable.

Unravelling current sexual care in chronic kidney disease: perspective of social workers.

BACKGROUND: Fifty to eighty percent of patients suffering from chronic kidney disease (CKD) experience a form of sexual dysfunction (SD), even after renal transplantation. Despite this, inquiring about SD is often not included in the daily practice of renal care providers. OBJECTIVES: This paper explores the perspectives of renal social workers regarding sexual care for patients and evaluates their practice, attitude towards responsibility and knowledge of SD. DESIGN: A cross-sectional study was conducted using a 41-item online survey. PARTICIPANTS: Seventy-nine members of the Dutch Federation of Social Workers Nephrology. RESULTS: It was revealed that 60% of respondents discussed SD with a fifth of their patients. Frequency of discussion was associated with experience (p = 0.049), knowledge (p = 0.001), supplementary education (p = 0.006), and the availability of protocols on sexual care (p = 0.007). Main barriers towards discussing SD consisted of 'culture and religion' (51.9%), 'language and ethnicity' (49.4%), and 'presence of a third person' (45.6%). Sufficient knowledge of SD was present in 28% of respondents. The responsibility for discussion was 96% nephrologists and 81% social workers. CONCLUSION: This study provides evidence that a part of Dutch nephrology social workers do not provide sexual care regularly, due to insufficient experience and sexual knowledge, absence of privacy and protocols and barriers based on cultural diversity. According to the respondents the responsibility for this aspect of care should be multidisciplinary. Recommendations include a need for further education on the topic, private opportunities to discuss SD and multidisciplinary guidelines on sexual care.

Sexual care for patients receiving dialysis: A cross-sectional study identifying the role of nurses working in the dialysis department.

AIMS: To explore the role of nurses in the dialysis department in providing sexual care to patients receiving dialysis. BACKGROUND: Sexual health is not self-evident for patients undergoing dialysis; 70% experience sexual dysfunction. Nevertheless, sexual care is often not provided. DESIGN: A national cross-sectional survey. METHODS: Questionnaires (n = 1211) were sent to employees of 34 dialysis centres from January-May 2016. Descriptive statistics and statistical tests were used to describe and interpret data. RESULTS: The response rate was 45.6%. Three-quarter of nurses discussed sexual dysfunction with less than half of their patients. Main barriers for discussing were based on language and ethnicity (57.3%), culture and religion (54.1%) and the older age of the patient (49.7%). Eighteen per cent of nurses had sufficient knowledge on sexual dysfunction, competence was present in 51.2% of nurses and 68.3% indicated a need for training. Forty-three per cent knew about guidelines on sexual care by renal care providers. Nurses who rated their knowledge or competence higher or who were aware of guidelines discussed sexuality more often. The accountability for discussing sexuality was appointed to nephrologists (82.8%) and their own group of professionals (66.3%). Nurses referred 1.16% of their patients to sexual care providers. CONCLUSION: Dialysis nurses do not consistently address patients' sexuality, although they feel accountable to do so. This seems due to self-imposed insufficient knowledge, cultural barriers and organizational problems. Study findings imply that current situation could benefit from guidelines, additional training, a private moment to discuss sexual dysfunction and adequate referral systems to specialized care providers.

The Discussion of Sexual Dysfunction Before and After Kidney Transplantation From the Perspective of the Renal Transplant Surgeon.

INTRODUCTION: Sexual dysfunction (SD) is a common problem in chronic kidney disease (CKD) and endures in 50% of patients after kidney transplantation (KTx), diminishing patients' expectations of life after KTx. Unfortunately, SD is often ignored by renal care providers. Research questions as part of a research project among all renal care providers, transplant surgeons' perspectives were obtained on sexual health care for KTx recipients, including their opinion on who should be accountable for this care. In addition, surgeons' practice and knowledge regarding SD were evaluated. DESIGN: A 39-item questionnaire was sent to all Dutch surgeons and residents specialized in KTx (n = 47). RESULTS: Response was 63.8%. None of the respondents discussed SD with their patients, before or after surgery. Most important barrier was that surgeons do not feel accountable for it (73.9%); 91.7% thought this accountability should lie with the nephrologist. Another barrier was insufficient knowledge (39.1%). In 75% of the respondents, (almost) no knowledge regarding SD was present and 87.5% noticed education on SD was insufficient during residence training. DISCUSSION: Dutch renal transplant surgeons rarely discuss SD with their patients with CKD, as they do not feel accountable for it; this accountability was appointed to the nephrologist. Knowledge and education regarding SD were found insufficient in enabling surgeons and for some it reflects in barriers toward discussing SD. Results emphasize that accountability for providing sexual health care to patients with CKD should lie elsewhere; however, surgeons could briefly provide information on sexual health after KTx, so unfulfilled expectations may be prevented.

What is the role of nephrologists and nurses of the dialysis department in providing fertility care to CKD patients? A questionnaire study among care providers.

PURPOSE: This study evaluated current fertility care for CKD patients by assessing the perspectives of nephrologists and nurses in the dialysis department. METHODS: Two different surveys were distributed for this cross-sectional study among Dutch nephrologists (N = 312) and dialysis nurses (N = 1211). RESULTS: Response rates were 50.9% (nephrologists) and 45.4% (nurses). Guidelines on fertility care were present in the departments of 9.0% of the nephrologists and 15.6% of the nurses. 61.7% of the nephrologists and 23.6% of the nurses informed ≥50% of their patients on potential changes in fertility due to a decline in renal function. Fertility subjects discussed by nephrologists included "wish to have children" (91.2%), "risk of pregnancy for patients' health" (85.8%), and "inheritance of the disease" (81.4%). Barriers withholding nurses from discussing FD were based on "the age of the patient" (62.6%), "insufficient training" (55.2%), and "language and ethnicity" (51.6%). 29.2% of the nurses felt competent in discussing fertility, 8.3% had sufficient knowledge about fertility, and 75.7% needed to expand their knowledge. More knowledge and competence were associated with providing fertility health care (p < 0.01). CONCLUSIONS: In most nephrology departments, the guidelines to appoint which care provider should provide fertility care to CKD patients are absent. Fertility counseling is routinely provided by most nephrologists, nurses often skip this part of care mainly due to insufficiencies in self-imposed competence and knowledge and barriers based on cultural diversity. The outcomes identified a need for fertility guidelines in the nephrology department and training and education for nurses on providing fertility care.

Sling Surgery for the Treatment of Urinary Incontinence After Transurethral Resection of the Prostate: New Data on the Virtue Male Sling and an Evaluation of Literature.

OBJECTIVE: To provide a review of literature regarding the role of male slings in the treatment of stress urinary incontinence (SUI) following a transurethral resection of the prostate (TURP) and to evaluate the effects of the Virtue male sling in patients with post-TURP SUI. MATERIALS AND METHODS: A systematic review of literature was performed to identify all papers on the use of male slings in patients with post-TURP SUI. Second, a prospective cohort study was conducted on 8 patients who received the Virtue as surgical treatment of post-TURP SUI. Questionnaires were collected preoperatively and 1, 3, 6, and 12 months postoperatively. Success and improvement were defined as pad usage (0 pads: success, pad reduction of ≥50%: improvement). Primary end point was the continence rate 1 year postoperatively. Data were analyzed using the paired 2-tailed t test. RESULTS: Sling surgery appears to be significantly less successful in the treatment of SUI post TURP when compared to other types of prostate surgery. The clinical trial on the Virtue sling observed continence in 4 of 8 patients, with another 2 patients with improved continence after 1-year follow-up. No difference in success was observed between patients with mild and patients with severe SUI. CONCLUSIONS: Little is currently known about the effects of sling surgery in patients with mild to severe SUI following a TURP. Although the Virtue male sling seems to be an efficient and safe device in the treatment of this complication, longer follow-up and larger cohorts will be needed to further confirm these results.

Omissions in Urology Residency Training Regarding Sexual Dysfunction Subsequent to Prostate Cancer Treatment: Identifying a Need.

OBJECTIVE: To assess urology residents' current knowledge, practice, previous training, barriers, and training needs regarding prostate cancer treatment-related sexual dysfunction. MATERIALS AND METHODS: A cross-sectional questionnaire study inventoried the practice patterns and training need of urology residents attending a national training course in June 2015. RESULTS: Of 101 urology residents throughout the Netherlands, 87 attended the training (response rate 100%). Median age was 32 years (range 28-38); 55.2% were woman. Regardless of the residency level, most trainees had never received education about sexual dysfunction (58.6%), reported a limited level of knowledge (48.3%), and indicated an evident need for training (69.4%). The majority did not feel competent to advise prostate cancer patients regarding the treatment of sexual dysfunction (55.2%). Almost all participants inquired about preoperative erectile dysfunction (89.7%), and always informed about treatment-related sexual dysfunction (88.5%). At follow-up, 63.9% of the residents routinely addressed sexual complaints again. More than half of the participants indicated that urology residency training does not provide sufficient education on sexual dysfunction (54.8%).Time constraint (67.1%) and lack of training (35.3%) were the most frequently mentioned barriers. CONCLUSION: Current urology residency does not pay sufficient attention to sexual communication skills and sexual dysfunction. The residents require more knowledge about and more practical training in sexual counseling. Findings support efforts to enhance the education of urology residents regarding prostate cancer treatment-related sexual dysfunction.

Dealing with patients facing a history of sexual abuse: A cross-sectional survey among Dutch general practitioners.

BACKGROUND: Sexual abuse (SA) is a common problem. As the primary confidant, the general practitioner (GP) has a valuable role in identifying a history of abuse, specifically with regard to the commonly performed pelvic examination for cervical cancer screening. OBJECTIVES: This study focused on GPs' practice patterns, knowledge, training need and barriers concerning asking patients about SA. Furthermore, it was investigated who performs the cervical smear within the practice and if SA is taken into consideration. METHODS: The authors constructed a 31-item questionnaire, which was sent to a group of 730 Dutch GPs in September 2012. RESULTS: The response rate was 49.3%. Half of the 357 responding GPs asked their patients about SA sometimes. The majority (76.2%) stated they had some knowledge of SA. The most important barriers for not asking were 'no angle or motive for asking' (81.6%), 'presence of third parties' (73.1%), and 'not enough training' (54.1%). In most practices (84.3%), the nurse practitioner (NP) was assigned to perform the cervical smears, of which 34.8% presumably never ask about SA in advance. Additional training was in need according to 68.6%. GPs desired a clinical practice guideline regarding the counselling of SA (83.5%). CONCLUSION: This study showed SA is an under-evaluated problem in general practice, yet GPs are motivated to improve knowledge and counselling skills. NPs perform most of the cervical smears, but the majority never or rarely asked about SA in advance. Educational training and a clinical guideline regarding SA would be appreciated and hence recommended.

Discussing Sexual Dysfunction with Chronic Kidney Disease Patients: Practice Patterns in the Office of the Nephrologist.

INTRODUCTION: Sexual dysfunction (SD) is a common problem in patients suffering from chronic kidney disease (CKD). Sexual health remains a difficult subject to detect and discuss. Although many studies have been performed on the incidence of SD, little is known about practice patterns when it concerns quality of life (QoL)-related questions such as SD in the nephrologists' practice. AIM: The aim of this study was to determine to which extent nephrologists, important renal care providers, discuss SD with their patients and their possible barriers toward discussing this subject. METHODS: A 50-item questionnaire was sent to all Dutch nephrologists (n = 312). MAIN OUTCOME MEASURES: The survey results. RESULTS: The response rate of the survey was 34.5%. Almost all responders (96.4%) stated to address SD in less than half of their new patients. The most important barrier not to discuss SD was patients not expressing their concern regarding SD spontaneously (70.8%). Other important barriers were: "the lack of a suitable moment to discuss" (61.9%) and "insufficient time" (46.9%). Eighty-five percent of the nephrologists stated that insufficient attention was paid to SD and treatment options during their training. Sixty-five percent of the respondents stated to be in need of extending their knowledge on the discussing of SD. CONCLUSIONS: Dutch nephrologists do not discuss problems with sexual function routinely. The lack of knowledge, suitable education, and insufficient time are factors causing undervaluation of SD in CKD patients. Implementation of competent sexual education and raising awareness among nephrologists on the importance of paying attention to SD could improve care and QoL for patients with CKD. More research should be performed among patients and other renal care providers to develop an adequate method to enhance our current system.

Sexual Concerns after (Pelvic) Radiotherapy: Is There Any Role for the Radiation Oncologist?

INTRODUCTION: Sexual function is an important aspect of quality of life, and may be impaired after (pelvic) radiation. AIM: The aim of this study was to identify practice, responsibility attitudes, knowledge, and barriers of Dutch radiation oncologists regarding sexual counseling. METHODS: A cross-sectional survey was performed using a 28-item questionnaire sent to all members of the Dutch Society for Radiotherapy and Oncology. MAIN OUTCOME MEASURES: Self-reported practice, knowledge, barriers, need for training and responsibility attitudes in regard to demographic characteristics. RESULTS: Of the surveyed sample, 54.6% of the radiation oncologists completed the instrument (n = 119). Frequency of discussing sexual function was fluctuating, depending on the type of tumor. The majority of the responding radiation oncologists (75%) agreed that discussing sexual function is their responsibility, about one-third (33.6%) pointed at the involved specialist (surgeon, urologist, gynecologist, or oncologist), a fifth also considered the general practitioner responsible (21%). Additional training about discussing sexuality was required according to 44.4%, the majority agreed that sexual counseling should be a regular component of radiation oncology residency (n = 110, 94%). Barriers most mentioned included patient is too ill (36.2%), no angle or reason for asking (32.4%), advanced age of the patient (27%) and culture/religion (26.1%). For prostate cancer patients, phosphodiesterase 5 inhibitor information was supplied regularly (49.2%) and often (40.7%). CONCLUSIONS: Radiation oncologists generally perform sexual counseling in case of pelvic radiation therapy, but not consistently in case of gastrointestinal, breast, and other cancers. The majority of radiation oncologists considered counseling on sexual functioning as a part of their job, some also pointed at the referring specialist or general practitioner. The findings suggest that awareness about sexual dysfunction is present among radiation oncologists, but responsibility for active counseling is uncertain. Results emphasize the need for providing educational and practical training, as well as a list for specialized referral.