Female sexual dysfunction post radical cystectomy and urinary diversion.

OBJECTIVES: To evaluate the impact of radical cystectomy and urinary diversion on female sexual function. MATERIALS AND METHODS: A Medline search was conducted according to the PRISMA statement for all English full-text articles published between 1980 and 2016 and assessing female sexual function post radical cystectomy and urinary diversion. Eligible studies were subjected to critical analysis and revision. The primary outcomes were the reporting methods for female sexual dysfunction (FSD), manifestations of FSD, and factors associated with FSD, postoperative recoverability of FSD, and awareness level regarding FSD. RESULTS: From the resulting 117 articles, 11 studies were finally included in our systematic review, with a total of 361 women. Loss of sexual desire and orgasm disorders were the most frequently reported (49% and 39%). Dyspareunia and vaginal lubrication disorders were reported in 25% and 9.5%, respectively. The incidence of sexual dysfunction was 10% in 30 patients receiving genital- or nerve-sparing cystectomy vs. 59% receiving conventional cystectomy. CONCLUSION: Although female sexual function is an important predictor of health-related quality of life post radical cystectomy and urinary diversion, the available literature is not enough to provide proper information for surgeons and patients.

Fate of accessory renal arteries in grafts with multiple renal arteries during live-donor renal allo-transplantation.

INTRODUCTION: To determine risk factors for and the effects of impaired perfusion (IP)-"reduced or non-perfusion"-of graft areas supplied by an accessory artery on allograft function. OBJECTIVES: One hundred five consecutive grafts with multiple renal arteries were prospectively evaluated using Doppler ultrasound (US) to detect the perfusion of allograft segments supplied by the accessory artery. We studied factors predicting and the effects of IP on graft function. RESULTS: Doppler US diagnosed IP of allograft accessory arteries in 11 (10.5%) allografts. Mean values ± standard deviations and median (range) of renographic clearance of grafts with IP were 50.5 ± 26 and 40 (range, 21-92) mL/min, while those of grafts with patent accessory arteries were 68.6 ± 18.9 and 67.2 (range 21-117; P < .01). The percentage change in renographic clearance before versus after transplantation increased among grafts with patent arteries and decreased for those with IP (P = .03). On multivariate analysis, factors predicting IP of the accessory artery were delayed graft function (odds ratio [OR] = 9.9; 95% confidence interval [CI] = 1.6-58.6; P = .01) and upper polar arteries (OR = 8.9; 95% CI = 1.8-43.4; P < .01). CONCLUSION: When considering transplants with accessory arteries, greatest attention and efforts should be exerted on upper polar arteries to avoid delayed graft function.