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1.
JAMA ; 323(2): 149-163, 2020 01 14.
Artigo em Inglês | MEDLINE | ID: mdl-31935027

RESUMO

Importance: Understanding adverse effects of contemporary treatment approaches for men with favorable-risk and unfavorable-risk localized prostate cancer could inform treatment selection. Objective: To compare functional outcomes associated with prostate cancer treatments over 5 years after treatment. Design, Setting, and Participants: Prospective, population-based cohort study of 1386 men with favorable-risk (clinical stage cT1 to cT2bN0M0, prostate-specific antigen [PSA] ≤20 ng/mL, and Grade Group 1-2) prostate cancer and 619 men with unfavorable-risk (clinical stage cT2cN0M0, PSA of 20-50 ng/mL, or Grade Group 3-5) prostate cancer diagnosed in 2011 through 2012, accrued from 5 Surveillance, Epidemiology and End Results Program sites and a US prostate cancer registry, with surveys through September 2017. Exposures: Treatment with active surveillance (n = 363), nerve-sparing prostatectomy (n = 675), external beam radiation therapy (EBRT; n = 261), or low-dose-rate brachytherapy (n = 87) for men with favorable-risk disease and treatment with prostatectomy (n = 402) or EBRT with androgen deprivation therapy (n = 217) for men with unfavorable-risk disease. Main Outcomes and Measures: Patient-reported function, based on the 26-item Expanded Prostate Index Composite (range, 0-100), 5 years after treatment. Regression models were adjusted for baseline function and patient and tumor characteristics. Minimum clinically important difference was 10 to 12 for sexual function, 6 to 9 for urinary incontinence, 5 to 7 for urinary irritative symptoms, and 4 to 6 for bowel and hormonal function. Results: A total of 2005 men met inclusion criteria and completed the baseline and at least 1 postbaseline survey (median [interquartile range] age, 64 [59-70] years; 1529 of 1993 participants [77%] were non-Hispanic white). For men with favorable-risk prostate cancer, nerve-sparing prostatectomy was associated with worse urinary incontinence at 5 years (adjusted mean difference, -10.9 [95% CI, -14.2 to -7.6]) and sexual function at 3 years (adjusted mean difference, -15.2 [95% CI, -18.8 to -11.5]) compared with active surveillance. Low-dose-rate brachytherapy was associated with worse urinary irritative (adjusted mean difference, -7.0 [95% CI, -10.1 to -3.9]), sexual (adjusted mean difference, -10.1 [95% CI, -14.6 to -5.7]), and bowel (adjusted mean difference, -5.0 [95% CI, -7.6 to -2.4]) function at 1 year compared with active surveillance. EBRT was associated with urinary, sexual, and bowel function changes not clinically different from active surveillance at any time point through 5 years. For men with unfavorable-risk disease, EBRT with ADT was associated with lower hormonal function at 6 months (adjusted mean difference, -5.3 [95% CI, -8.2 to -2.4]) and bowel function at 1 year (adjusted mean difference, -4.1 [95% CI, -6.3 to -1.9]), but better sexual function at 5 years (adjusted mean difference, 12.5 [95% CI, 6.2-18.7]) and incontinence at each time point through 5 years (adjusted mean difference, 23.2 [95% CI, 17.7-28.7]), than prostatectomy. Conclusions and Relevance: In this cohort of men with localized prostate cancer, most functional differences associated with contemporary management options attenuated by 5 years. However, men undergoing prostatectomy reported clinically meaningful worse incontinence through 5 years compared with all other options, and men undergoing prostatectomy for unfavorable-risk disease reported worse sexual function at 5 years compared with men who underwent EBRT with ADT.


Assuntos
Antagonistas de Androgênios/efeitos adversos , Braquiterapia/efeitos adversos , Medidas de Resultados Relatados pelo Paciente , Prostatectomia/efeitos adversos , Neoplasias da Próstata/terapia , Radioterapia/efeitos adversos , Idoso , Antagonistas de Androgênios/uso terapêutico , Terapia Combinada , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/radioterapia , Neoplasias da Próstata/cirurgia , Radioterapia/métodos , Disfunções Sexuais Fisiológicas/etiologia , Resultado do Tratamento , Incontinência Urinária/etiologia , Conduta Expectante
2.
BJOG ; 127(1): 28-35, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31541614

RESUMO

BACKGROUND: Mesh surgery for stress urinary incontinence or pelvic organ prolapse can result in complications such as mesh exposure, mesh extrusion, voiding dysfunction, dyspareunia, and pain. There is limited knowledge or guidance on the effective management for mesh-related complications. OBJECTIVE: To determine the best management of mesh complications; a systematic review was conducted as part of the national clinical guideline 'Urinary incontinence (update) and pelvic organ prolapse in women: management'. SEARCH STRATEGY: Search strategies were developed for each indication for referral. SELECTION CRITERIA: Relevant interventions included complete or partial mesh removal, mesh division, and non-surgical treatments such as vaginal estrogen. DATA COLLECTION AND ANALYSIS: Characteristics and outcome data were extracted, and as a result of the heterogeneous nature of the data a narrative synthesis was conducted. MAIN RESULTS: Twenty-four studies were included; five provided comparative data and four studies stated the indication for referral. Reported outcomes (including pain, dyspareunia, satisfaction, quality of life, incontinence, mesh exposure, and recurrence) and the reported incidences of these varied widely. CONCLUSIONS: The current evidence base is limited in quantity and quality and does not permit firm recommendations to be made on the most effective management for mesh-related complications. Robust data are needed so that mesh complications can be managed effectively in the future. TWEETABLE ABSTRACT: Systematic review demonstrates that the outcomes following mesh revision surgery are highly variable.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Telas Cirúrgicas/efeitos adversos , Incontinência Urinária por Estresse/cirurgia , Adolescente , Adulto , Idoso , Perda Sanguínea Cirúrgica , Dispareunia/etiologia , Feminino , Humanos , Complicações Intraoperatórias/etiologia , Pessoa de Meia-Idade , Satisfação do Paciente , Complicações Pós-Operatórias/etiologia , Qualidade de Vida , Recidiva , Disfunções Sexuais Fisiológicas/etiologia , Resultado do Tratamento , Adulto Jovem
3.
Int Braz J Urol ; 45(6): 1216-1226, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31808411

RESUMO

INTRODUCTION AND OBJECTIVE: Several studies have focused on the treatment and recurrence of urethral diverticulum (UD). However, few investigations have addressed sexual function in pati-ents with UD. Therefore, we sought to examine sexual function in women affected by UD. MATERIALS AND METHODS: There were 108 accepted cases involving transvaginal diverticulectomy at our institution. Ultimately, 83 women were included for further analysis, only 61 of these wo-men had sexual partners. We collected data for the Female Sexual Function Index (FSFI) from the female patients and the Male Sexual Health Questionnaire (MSHQ) from their male partners before and after surgery. RESULTS: Preoperatively, the UD size affected the female patient's arousal and lubrication (p=0.04), and the UD location affected their satisfaction. However, no significant between-group differences were found in the total FSFI score. For all women, sexual activity improved after surgery (p=0.0087). In addition to improvements in arousal for women with a large UD, improvements in lubrication were affected by the UD size, number and shape, increases in sa-tisfaction scores were impacted by the UD location and shape, and pain relief was linked to the UD number and shape. Analysis of the MSHQ results revealed no between-group differences among the male partners. CONCLUSION: Only the UD size and location affected sexual function in women with a small UD. Surgery could improve female sexual function but did not affect the sexual function of the patient's partners.


Assuntos
Divertículo/cirurgia , Complicações Pós-Operatórias/etiologia , Disfunções Sexuais Fisiológicas/etiologia , Doenças Uretrais/cirurgia , Adulto , Divertículo/fisiopatologia , Ejaculação/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Complicações Pós-Operatórias/fisiopatologia , Valores de Referência , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Disfunções Sexuais Fisiológicas/fisiopatologia , Parceiros Sexuais , Inquéritos e Questionários , Doenças Uretrais/fisiopatologia
4.
BMC Neurol ; 19(1): 255, 2019 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-31656168

RESUMO

BACKGROUND: Many patients with chronic illness have sexual dysfunction that may be related to the condition itself, drug side effects, emotional sequel, or a combination of those factors. Patients with epilepsy are no exception. Men and women with epilepsy are frequently complaining sexual dysfunction and they appear to have a higher incidence of sexual dysfunction than peoples with other chronic neurologic illness. These problems can have a substantial impact on their sexuality thus; it needs careful study and evaluation. METHODS: Hospital based cross sectional study was conducted from January to July, 2016 among Patient with Epilepsy at Amanuel Mental Specialty Hospital. Interviewer administered Changes in Sexual Functioning Questionnaire (CSFQ-14) was used in order to assess the sexual problems. Finally, the data was analyzed by using Statistical Package for Social Science (SPSS) V-20. Descriptive statistics and logistic regression were used to describe the variables. Levels of significance of association determined at < 0.05. RESULTS: A total of 694 respondents participated, with response rate 99.14%. Among them 576 completed all items. The result showed that 363 subjects (63.9, 95%CI = 59.5-67.7) had global sexual dysfunction. Furthermore, the rate of sexual dysfunction was reported as 55.6% (95%CI = 49.1-62.6) and 67.4% (95%CI = 62.8-72.1) in female and male participants, respectively. Among domains of sexual dysfunction; sexual arousal problem (97.8% (95%CI = 95.8-98.3)) and sexual pain problem (11.3% (95%CI = 8.8-13.9)) were the most and the least prevalent sexual dysfunctions respectively. Concerning associated factors; age grouped > 51, depression, being out of relationship or not satisfied with non-sexual aspect of relationship, being jobless and khat use has positive association with sexual dysfunction. By the other side alcohol use, level of education & age groups 18-21 years associated negatively. CONCLUSIONS: The prevalence of sexual dysfunction among patients with epilepsy is very high; its prevalence is more among males than females. Sexual arousal problem and sexual pain problem were the most and the least prevalent sexual dysfunctions respectively.


Assuntos
Epilepsia/complicações , Disfunções Sexuais Fisiológicas/epidemiologia , Disfunções Sexuais Fisiológicas/etiologia , Adolescente , Adulto , Estudos Transversais , Etiópia/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
5.
Orv Hetil ; 160(41): 1617-1622, 2019 Oct.
Artigo em Húngaro | MEDLINE | ID: mdl-31587579

RESUMO

Introduction: Genitourinary syndrome of menopause (GSM) affects up to 40-57% of postmenopausal women. Intravaginal microablative fractional CO2 laser is a new proposal for the management of GSM, although the evidence of safety and efficacy of the procedure appears to be insufficient. Aim: The aim of the study was to assess the efficacy of fractional CO2 laser for the treatment of GSM at the Department of Obstetrics and Gynecology of the University of Debrecen. Method: Postmenopausal women with symptoms of GSM underwent three sessions of microablative fractional rejuvenation CO2 laser therapy at 4-6 weeks intervals. Vaginal health index (VHI) scores were completed before each treatment and at 6 weeks follow-up as an objective measurement and visual analog scale was used to assess subjective complaints. Statistical analysis included Student's paired two-sampling t-test for the measure of statistical significance using the standard cutoff for significance p<0.05. Results: 51 women participated (mean age 57.0 ± 9.9 y). Average VHI score was 14.0 ± 4.9 before treatment, 15.0 ± 4.7 after the first session, 18.2 ± 4.6 after the second treatment and 19.5 ± 4.9 at follow-up. The improvement of VHI score was statistically significant between all sessions. Average VAS score was 15.6 ± 14.1 before treatment, 9.0 ± 10.8 after the first session, 5.9 ± 9.2 after the second treatment and 3.4 ± 7.5 at follow-up. The improvement of VAS score was statistically also significant between all sessions. Conclusions: Our study suggests that the fractional CO2 laser is an effective and safe treatment of symptoms associated with GSM. Orv Hetil. 2019; 160(41): 1617-1622.


Assuntos
Dióxido de Carbono/uso terapêutico , Dispareunia/cirurgia , Doenças Urogenitais Femininas/cirurgia , Terapia a Laser , Lasers de Gás/uso terapêutico , Menopausa , Disfunções Sexuais Fisiológicas/cirurgia , Doenças Vaginais/cirurgia , Idoso , Dispareunia/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Disfunções Sexuais Fisiológicas/etiologia , Síndrome , Resultado do Tratamento
6.
Pan Afr Med J ; 33: 165, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31579121

RESUMO

Spinal dysraphism (or spina bifida) is a neurological disorder representing the first cause of congenital urological disability. It has several clinical manifestations, vesicosphincteric and sexual disorders are frequent and rarely isolated, belonging to motor disorders, orthopedic, sensory, digestive or even cognitive impairments. Tethered cord syndrome at the base of the spinal canal is a complication of spinal dysraphism. This disorder is often detected in children, may be asymptomatic and found in adults. Bladder sphincter disorders are the main cause of morbi-mortality due to uronephrologic complications with a significant alteration in quality of life. This justifies specific management and multidisciplinary and strict monitoring. We here report an exceptional case of spinal dysraphism such as tethered cord syndrome at the base of the spinal canal found incidentally in an adult patient during an etiological assessment of lithiasis of the prostatic urethra associated with anejaculation .


Assuntos
Defeitos do Tubo Neural/diagnóstico , Disfunções Sexuais Fisiológicas/etiologia , Disrafismo Espinal/diagnóstico , Cálculos Urinários/diagnóstico , Adulto , Humanos , Achados Incidentais , Masculino , Qualidade de Vida , Canal Vertebral/patologia , Disrafismo Espinal/fisiopatologia , Uretra/patologia , Cálculos Urinários/complicações
7.
Br J Nurs ; 28(16): S4-S15, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31518529

RESUMO

BACKGROUND: stoma formation is performed on many women with colorectal cancer. The physical effects of this are well known and explained to patients by health professionals. Stoma formation also affects sexual function for a variety of emotional and physical reasons, but this appears to be inadequately discussed. AIM: this literature review examined women's experience of sexual function after stoma formation. METHOD: five electronic databases were searched for peer-reviewed studies in the English language. Ancestry searches were also performed on the reference lists of the literature identified in this search. FINDINGS: three themes emerged from the review: bodily disturbance; intimate relationships; and devaluation of sexuality. Body image is significantly disturbed by stoma formation, affecting self-esteem and satisfaction with the self. Altered bodily function, with odour and sounds from the stoma bag, is distressing to women. Women find a stoma difficult to accept, and partners'/husbands' acceptance of it has a large impact on how they feel about themselves. Sexual function is commonly overlooked in clinical settings, with health professionals prioritising physical and mental health over sexuality. CONCLUSIONS: stoma formation commonly has negative effects on women's sexual function and these should be more thoroughly addressed in healthcare settings. All the publications the author found examined heterosexual relationships and the experience of homosexual women should be studied.


Assuntos
Neoplasias Colorretais/cirurgia , Disfunções Sexuais Fisiológicas/etiologia , Estomas Cirúrgicos/efeitos adversos , Feminino , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
8.
Wien Klin Wochenschr ; 131(21-22): 541-549, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31493101

RESUMO

Low back pain (LBP) is a widely prevalent chronic pain disorder associated with a high burden on individuals and society. In the subjective perception of patients with LBP, probably the most important health outcomes associated with LBP are those that effect everyday performance. Such outcomes include reduction in activities of daily living (ADL), in work ability (WA), and in sexual function. This narrative review aimed to (1) examine the association between LBP and the three mentioned outcomes of everyday performance, (2) to explain possible mediating factors promoting these associations, and (3) to discuss possible implications for treatment and rehabilitation. Studies have shown that LBP can generate anxiety of movement leading to movement avoidance (fear-avoidance beliefs), which may lead to deconditioning and further increasing problems with ADL, WA and decreasing sexual function. Furthermore, common mental disorders, such as depression, anxiety, and stress-related disorders, which also often co-occur with LBP can lead to adverse effects on everyday performance and vice versa, can be the consequence of such problems and aggravate LBP. Although there is no universally accepted treatment modality that fits every patient with LBP, physical training, comprehensive patient education, and workplace or home modifications have been shown to be able to interrupt the mutual influence between LBP and the described mediating factors, and have a beneficial effect on ADL, WA, and sexual function. For this, a multidisciplinary approach is necessary which includes multiprofessional care teams, participation of the patients, and involvement of different settings, such as workplace, home, and physical training facilities.


Assuntos
Atividades Cotidianas , Dor Lombar , Disfunções Sexuais Fisiológicas , Trabalho , Doença Crônica , Medo , Humanos , Disfunções Sexuais Fisiológicas/epidemiologia , Disfunções Sexuais Fisiológicas/etiologia , Inquéritos e Questionários
9.
J Clin Neurosci ; 68: 20-27, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31350078

RESUMO

AIM: The aim of this study is to define an overview of the impact of SCI on male sexuality and provide a framework for the pathophysiology and the treatment of sexual dysfunction in male with SCI. METHODS: This scoping review was conducted to identificate pathophysiology and the treatment of sexual dysfunction in SCI male. Studies were identified by searching on PubMed, Web Of Science and Cochrane databases during January 2010-July 2018. RESULTS: Despite sexual dysfunction in men with SCI varies due to complete or incomplete spinal injuries, treatment sexual intercourse should also be implemented in cases of paralysis and loss of sensitivity. This treatment should be integrated with the remaining sexual potential of the individual, based on rehabilitation programs. CONCLUSIONS: Our review suggests that it is necessary to increase knowledge about the management of sexual concerns in patients with SCI, representing an important aspect in the patient's family, social and emotional life.


Assuntos
Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/fisiopatologia , Disfunções Sexuais Fisiológicas/terapia , Traumatismos da Medula Espinal/complicações , Adulto , Humanos , Masculino
10.
Prog Urol ; 29(8-9): 456-463, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31300267

RESUMO

AIM: The usual morbidity after radical prostatectomy (RP) implies, the possible need for inflatable penile prosthesis (IPP). This study aims to validate the efficacy and safety of a sling called "Mini-Jupette" concomitantly with the implantation of an IPP that will counteract mild UI (<2 pads/day) associated or not with climacturia for patients resistant to non-invasive therapeutic approach. METHODS: We provide a detailed description with robust illustration of an original surgical technique. The method the criteria analyzed in the study and the statistical method. Retrospective data from 15 patients from 2006 to 2016 are detailed. RESULTS: Data about erectile function, continence before and after operation are documented for this cohort with mild incontinence (15pts - 100% - mean pad/day was 1.5, SD=0.6) and climacturia (6pts-40%). Mean age was 65.9 years (SD=6.3). There were no complications but 2 patients had dysuria and one patient present urinary retention requiring temporary bladder drainage. At 6 months, incontinence were objectively cured for 80% of patients and 2 patients (13%) improve their continence by a slight activation of the implant, the climacturia disappeared in 5 patients (82%). A telephone interview shows a good durability of the results. with a mean time of 107 months follow-up. CONCLUSION: Concomitant insertion of the "Mini-Jupette" sling during implantation of an IPP contributes reliably, safely and durably to the treatment of post-radical prostatectomy mild incontinence and/or climacturia. LEVEL OF EVIDENCE: 3.


Assuntos
Disfunção Erétil/cirurgia , Implante Peniano/métodos , Prostatectomia/efeitos adversos , Incontinência Urinária/cirurgia , Idoso , Disfunção Erétil/etiologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prótese de Pênis , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/cirurgia , Slings Suburetrais , Resultado do Tratamento , Incontinência Urinária/etiologia
11.
Taiwan J Obstet Gynecol ; 58(4): 505-513, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31307742

RESUMO

OBJECTIVES: This study aims to compare pelvic floor muscle (PFM) functions in midwifes and nurses of reproductive age with and without pelvic floor dysfunction (PFD) and investigate the relationship between PFM function and the number, type and symptoms of PFDs. MATERIALS AND METHODS: 82 midwifes and nurses of reproductive age with (n = 51) and without PFD (n = 31) participated in the study. PFM function was assessed by digital palpation using PERFECT scale. Gynecological examination, ultrasonography, disease-specific questionnaires, questions and tests were used to assess symptoms of PFD. PFD was assessed in terms of risk factors, urinary incontinence, fecal incontinence, pelvic organ prolapse (POP), pelvic pain and sexual dysfunctions. RESULTS: Power parameter of PERFECT scheme was significantly lower in subjects with PFD compared to Non-PFD group (p = 0.002). 41% of the subjects with Power 5 PFM strength in PFD group were diagnosed as stage 1 POP, 5.8% as stage 2 POP, 15.7% of urge incontinence, 23.3% of stress incontinence and 10.5% of mixed incontinence. Both urinary incontinence and POP were detected in 15.7% of them. Among all subjects, incontinence symptoms decreased whereas POP and sexual function did not change as PFM increased. PFM strength was negatively correlated with the number of PFD (p = 0.002, r = -0.34). The type of dysfunction did not correlate with PFM strength (p > 0.05). CONCLUSION: PFM strength only affects of urinary incontinence sypmtoms among all PFDs in midwifes and nurses of reproductive age. PFM strength may not be the main factor in the occurrence of PFDs as pelvic floor does not consist solely of muscle structure. However, it strongly affects the number of dysfunctions. Therefore, PFM training should be performed to prevent the occurrence of extra dysfunctions in addition to the existing ones even if it does not alter the symptoms.


Assuntos
Incontinência Fecal/fisiopatologia , Prolapso de Órgão Pélvico/complicações , Inquéritos e Questionários , Incontinência Urinária/fisiopatologia , Adulto , Fatores Etários , Estudos Transversais , Incontinência Fecal/epidemiologia , Incontinência Fecal/etiologia , Feminino , Exame Ginecológico/métodos , Humanos , Incidência , Pessoa de Meia-Idade , Tocologia , Força Muscular/fisiologia , Enfermeiras e Enfermeiros , Diafragma da Pelve/fisiopatologia , Distúrbios do Assoalho Pélvico/complicações , Distúrbios do Assoalho Pélvico/diagnóstico , Prolapso de Órgão Pélvico/diagnóstico , Prolapso de Órgão Pélvico/terapia , Prognóstico , Medição de Risco , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/fisiopatologia , Incontinência Urinária/epidemiologia , Incontinência Urinária/etiologia
12.
Eur J Obstet Gynecol Reprod Biol ; 239: 21-29, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31163353

RESUMO

OBJECTIVE: To analyze preoperative and postoperative sexual function following surgery for deeply infiltrating endometriosis (DIE) with and without bowel involvement. STUDY DESIGN: Patients with DIE who underwent surgery between 2001 and 2011 with segmental bowel resection (WB) or without segmental bowel resection (WOB) were surveyed using the German version of the Massachusetts General Hospital Sexual Functioning Questionnaire (KFSP). Responses were given on a six-point scale for the items sexual interest, sexual arousal, orgasm, lubrication, and general sexual satisfaction. As there are no cut-off values for the existence of sexual function disorders, a control group with no history of endometriosis was evaluated. Differences between the preoperative and postoperative results, as well as between WB, WOB, and a control group, were compared using the Wilcoxon test, Mann-Whitney U test, and Fisher's exact test. RESULTS: Eighty-nine patients without bowel resection (mean age 34.3 years; mean follow-up 63.2 months), 87 patients with bowel resection (mean age 37.7 years; mean follow-up 69.6 months), and 100 control patients aged 21-58 years (mean age 35.0 years) were evaluated. Preoperatively, both treatment groups had significantly poorer scores in all categories in comparison with the control group. The WOB group improved significantly in all categories postoperatively, with no further significant differences from the control group. No significant postoperative improvement was observed in the WB group, and the group had significantly poorer scores in comparison with the control group. The number of previous operations is associated with significantly poorer postoperative KFSP results. Sterility and age > 40 years are associated with significantly less improvement in the KFSP, although with lower initial values. CONCLUSIONS: Patients with DIE with or without bowel involvement have significantly impaired sexual function preoperatively. Complete resection of endometriosis in the WOB group was able to improve sexual function, as the women had sexual scores similar to those in the healthy control group postoperatively. Possible explanations for the lack of postoperative improvement of sexual function after segmental bowel resection include the type of surgery carried out, or injury to the affected nerves resulting from the endometriosis.


Assuntos
Endometriose/complicações , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Comportamento Sexual/fisiologia , Disfunções Sexuais Fisiológicas/etiologia , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Comportamento Sexual/psicologia , Adulto Jovem
13.
Medicina (Kaunas) ; 55(6)2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31163685

RESUMO

Background and objectives: Urinary incontinence is defined as the involuntary leakage of urine. Studies have reported that the severity of urinary incontinence symptoms can cause decreased quality of life and female sexual dysfunction in women, but the association between the duration of the incontinence and the aforementioned disturbances has not been evaluated. The objective of this study was to evaluate the differences in the occurrence of decreased quality of life and female sexual dysfunction in Croatian women with urinary incontinence, with regard to the duration and subtype of urinary incontinence. Materials and Methods: We conducted a cross-sectional study from March 2017 to July 2018 at our neurourology and urodynamics outpatient clinic, among 120 women with urinary incontinence symptoms. Based on medical history, physical exam and urodynamic assessment, participants were divided into groups with stress-, urgency- and mixed urinary incontinence. Several quality of life and female sexual dysfunction questionnaires were used for evaluation. The differences between the three UI groups were tested by the Kruskal-Wallis test. All p values were two-sided. The level of significance was set to Alpha = 0.05. Results: The mixed urinary incontinence group had a significantly inferior quality of life (p = 0.003) and lower scores on the female sexual dysfunction questionnaires (p = 0.02). The longer the duration of incontinence King's Health Questionnaire total score was worse (p = 0.003) and Female Sexual Function Index total score was worse (p < 0.001). Conclusions: Our results showed that there was a statistically significant difference in the occurrence of decreased quality of life and female sexual dysfunction considering the duration and subtype of incontinence in Croatian women.


Assuntos
Qualidade de Vida/psicologia , Disfunções Sexuais Fisiológicas/etiologia , Incontinência Urinária/complicações , Idoso , Distribuição de Qui-Quadrado , Croácia , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Disfunções Sexuais Fisiológicas/psicologia , Estatísticas não Paramétricas , Inquéritos e Questionários , Incontinência Urinária/psicologia
14.
Pol Przegl Chir ; 91(3): 21-26, 2019 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-31243171

RESUMO

INTRODUCTION: Low anterior resection of the rectum (LAR) is a treatment of choice in patients with diagnosed low rectal cancer. Rectal cancer surgery has a close relationship with the urinary-sexual organs and also with related nerves and nerve plexus. Thus, the sympathetic and parasympathetic nerves of the pelvic area may be damaged. As a result of this, the important point is the sexual function loss following rectal surgeries. The aim of the study was to investigate the sexual disorders in patients with rectal cancer who underwent LAR. MATERIALS AND METHODS: In this retrospective study the sexual activity, comfort of the experience, quality of sexual life (QoSL) during 3 periods were analyzed: before surgery, a month after and half a year after surgery. Analysis of demographic characteristics, comorbidities, previous surgeries, toumor characteristics and adjuvant therapy as was performed. RESULTS: Most patients (64/100, 64%) expressed that LAR operation has strongly affected their QoSL, 32 patients reported the mild decrease in QoSL, while only 4 patients stated that did not experience any changes in QoSL. QoSL was assessed in 3 different periods of time: before the operation, 1 month after and 6 months after the operation (22,6±3.7 vs. 11.3±7,9 vs. 17,0±6.3; p<0.0001 respectively). The decreased QoSL one and six months after the surgery were significantly lower in patients with diagnosed hypertension and higher BMI (p=0.0283). CONCLUSIONS: Sexual disorders after LAR for rectal cancer are often underestimated and it is very important to be aware of them. In our study, it was determined that male sex, higher BMI and hypertension are related to impair of sexual dysfunction after LAR. We observed that the most severe complaints related to sexual activity occur one month after the procedure, after 6 months in most of the patients' sexual disorders were decreased approaching the initial state.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Complicações Pós-Operatórias/etiologia , Neoplasias Retais/cirurgia , Disfunções Sexuais Fisiológicas/etiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reto/cirurgia , Estudos Retrospectivos
15.
Int J Radiat Oncol Biol Phys ; 105(2): 382-388, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31201895

RESUMO

PURPOSE: To analyze long-term quality-of-life (QoL) changes related to postoperative radiation therapy (RT) after radical prostatectomy. METHODS AND MATERIALS: Patients who received postoperative 3-dimensional conformal RT in the years 2003 to 2008 with 1.8 to 2.0 Gy fractions up to 66.0 to 66.6 Gy (n = 181) were surveyed using the Expanded Prostate Cancer Index Composite questionnaire before the beginning of RT (A); on the last day (B); and 2 months (C), 1 to 3 years (D), 6 to 9 years (E), and 10 to 13 years (F) after RT. RESULTS: Mean urinary bother, urinary incontinence bother, and bowel bother score changes (in relation to baseline at time A) of 13, 14, and 7 and 14, 15, and 7 were found at times E and F, respectively (P < .01 for all comparisons). Sexual function scores decreased 6 and 8 points on average (P < .01). Patient age at the time of RT had a considerable impact on urinary bother and urinary incontinence bother, with increasing differences over time when comparing patients aged <68 versus ≥68 years: 0 versus 7 and 0 versus 7 points at time D and 8 versus 23 and 6 versus 35 points at time F, respectively. Patients who did not respond to RT with a decreasing prostate-specific antigen level had greater urinary and urinary incontinence bother and bowel bother score changes >10 years after treatment (25 vs 12; P = .04, 36 vs 10; P = .03, and 20 vs 5; P = .07, respectively). A higher rectal dose was associated with greater acute and long-term bowel bother score decrease. No correlation was found between the dose to the bladder and QoL changes. CONCLUSIONS: In contrast to early evaluations in the first years, significantly decreasing QoL in the urinary, bowel, and sexual domains was found >5 years after RT. Aging is likely to be a major factor. Younger patients who responded to the treatment had the most favorable long-term QoL results. As 3-dimensional conformal RT was used in this study, intensity modulated concepts could result in improved outcomes.


Assuntos
Neoplasias da Próstata/radioterapia , Neoplasias da Próstata/cirurgia , Qualidade de Vida , Reto/efeitos da radiação , Bexiga Urinária/efeitos da radiação , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Tomada de Decisão Clínica , Inquéritos Epidemiológicos , Humanos , Calicreínas/sangue , Acontecimentos que Mudam a Vida , Irradiação Linfática , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Antígeno Prostático Específico/sangue , Prostatectomia , Neoplasias da Próstata/sangue , Dosagem Radioterapêutica , Radioterapia Conformacional/efeitos adversos , Radioterapia de Intensidade Modulada , Estudos Retrospectivos , Disfunções Sexuais Fisiológicas/etiologia , Fatores de Tempo , Incontinência Urinária/etiologia , Transtornos Urinários/etiologia
16.
BMJ Case Rep ; 12(6)2019 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-31208981

RESUMO

A 20-year-old woman recently married presented to the outpatient department of the hospital, with primary amenorrhea and difficulty in having coitus. Her height was 155 cm, breast development was normal for age, and other secondary sexual characters seemed normal. On local examination, external genitalia was normal looking, and there was no vaginal discharge. She had a blind vagina of 2 cm length. The ultrasound showed a normal-sized uterus and ovaries seemingly normal. Hormonal profile comprising serum follicle-stimulating hormone, luteinising hormone, prolactin and thyroid stimulating hormone were all within normal limits. Karyotyping was done, which showed a 46,XX pattern. The patient underwent vaginal surgery during which septum resection was done, and amnion grafting was performed to prevent stricture formation. The patient resumed successful coitus 3 months after surgery. There was no discomfort on coitus. She conceived 7 months later. Following this, the patient delivered a healthy baby boy through caesarean section at term.


Assuntos
Amenorreia/cirurgia , Âmnio/transplante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Disfunções Sexuais Fisiológicas/cirurgia , Vagina/cirurgia , Adulto , Amenorreia/etiologia , Cesárea , Coito , Feminino , Humanos , Gravidez , Resultado da Gravidez , Disfunções Sexuais Fisiológicas/etiologia , Vagina/anormalidades
17.
Minerva Med ; 110(4): 320-329, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31081305

RESUMO

INTRODUCTION: The sexual function (SF) in patients affected by malignancies represents an important aspect influencing the quality of life (QoL). The most frequent symptoms reported are the decreased sexual desire, dyspareunia, and/or problems with arousal or achieving orgasm. The present study is aimed at analyzing the available scientific evidence regarding the QoL and especially SF of patients affected by ovarian cancer who underwent surgical and medical treatment. EVIDENCE ACQUISITION: A preliminary research was conducted using Pubmed database with specific keywords combinations regarding SF, QoL and ovarian cancer. The principal findings considered in the present review were: the study design, the number of patients included in each study, the information about the malignancy (histology and stage of disease), the questionnaires administered and the principal findings concerning SF and QoL. EVIDENCE SYNTESIS: The studies selected were 5 prospective series and 3 case control cross-sectional studies. The scores used were focused on SF, QOL, fatigue and psychological aspects. All studies reported a decreased SF and QOL. Different factors coexist in the influence on outcomes such as physical, hormonal, psychological, self body image, and mechanic outcomes. CONCLUSIONS: SF represents a fundamental aspect strictly related with QoL. Patients with ovarian cancer (as well all oncological patients) experience a reduction in their SF after diagnosis of malignancy and they should receive adequate counseling regarding this aspect.


Assuntos
Neoplasias Ovarianas/complicações , Qualidade de Vida , Disfunções Sexuais Fisiológicas/etiologia , Feminino , Humanos
18.
Medicina (Kaunas) ; 55(5)2019 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-31075814

RESUMO

Background and objectives: Diabetes mellitus type 2 (T2DM) has been associated with several microvascular and macrovascular complications. However, studies regarding the predominant complications of T2DM in Ghana have not been conducted. This study evaluated the prevalence and predominant complications of T2DM and assessed the sociodemographic factors associated with the development of diabetes-related complications in Kumasi, Ghana. Materials and Methods: This was a retrospective cross-sectional study conducted at Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. A total of 1600 Ghanaian T2DM adults were included in this study. Patients' clinical data from 2012 to 2016 were retrieved from the hospital's archive. Results: The prevalence of macrovascular and microvascular complications of T2DM was 31.8% and 35.3% respectively. The prevalence of neuropathy, nephropathy, retinopathy, sexual dysfunction, diabetic keto-acidosis (DKA), and hypoglycemia were 20.8%, 12.5%, 6.5%, 3.8%, 2.0%, and 0.8% respectively. Sexual dysfunction was significantly associated with the male gender compared to females. Being employed: Informal (aOR = 0.479, p < 0.0001), and Formal (aOR = 0.475, p = 0.0008) was associated with lower age- and sex-adjusted odds of developing T2DM-related complications while having T2DM for 5-10 years (aOR = 1.550, p = 0.0009) and more than 10 years (aOR = 2.755, p < 0.0001) was associated with increased odds of developing complications. Conclusions: Microvascular complication is the most predominant among T2DM in Kumasi, Ghana. The most prevalent T2DM-related microvascular complication in Kumasi, Ghana is neuropathy. Sexual dysfunction is associated with male compared to female T2DM patients. Being employed reduces the chance of developing T2DM-related complications while increasing DM duration increases the risk of complications.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Adulto , Idoso , Estudos Transversais , Diabetes Mellitus Tipo 2/epidemiologia , Cetoacidose Diabética/epidemiologia , Cetoacidose Diabética/etiologia , Nefropatias Diabéticas/epidemiologia , Nefropatias Diabéticas/etiologia , Neuropatias Diabéticas/epidemiologia , Neuropatias Diabéticas/etiologia , Retinopatia Diabética/epidemiologia , Retinopatia Diabética/etiologia , Feminino , Gana , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Disfunções Sexuais Fisiológicas/epidemiologia , Disfunções Sexuais Fisiológicas/etiologia
19.
Jpn J Clin Oncol ; 49(9): 812-822, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31095338

RESUMO

BACKGROUND: Optimal cancer survivorship care needs its comprehensive guidelines. We aimed to identify English and Japanese guidelines that include cancer survivorship in their title, the issues highlighted in such guidelines, and any existing oncology practice guidelines in Japan that address these issues. METHODS: This literature review was performed in three stages. First, guidelines published in English or Japanese that included cancer survivorship in the title were identified. Then, the issues that each cancer survivorship guideline addressed were defined. Lastly, Japanese guidelines that include survivorship issues were sought. RESULTS: Six guidelines published in English addressed 31 cancer survivorship issues. No specific cancer survivorship guideline was available in Japanese. Thirty-four Japanese guidelines mentioned cancer survivorship issues. These guidelines addressed screening/surveillance for detecting recurrence or secondary cancer but did not address coordination of care, implications for practice, or inclusion of family. At present, Japanese guidelines poorly address the issue of promotion of a healthy lifestyle in cancer survivors. Also, poorly addressed were long-term and late effects such as pain, psychological distress, fatigue, cognitive dysfunction, cardiovascular effects (including anthracycline-induced cardiac toxicity), sleep disorders, and sexual dysfunction in cancer survivors. CONCLUSION: There is a need for guidelines on optimal coordination of care between oncologists and other health care providers to support patients along the cancer care continuum and specifically to encourage a healthy lifestyle as part of cancer survivorship. The development of a comprehensive Japanese guideline that addresses these issues would help to improve the clinical outcome for cancer survivors in Japan.


Assuntos
Sobreviventes de Câncer/psicologia , Neoplasias/patologia , Guias de Prática Clínica como Assunto , Antineoplásicos/efeitos adversos , Doenças Cardiovasculares/induzido quimicamente , Doenças Cardiovasculares/etiologia , Disfunção Cognitiva/etiologia , Fadiga/induzido quimicamente , Fadiga/etiologia , Feminino , Humanos , Japão , Linguagem , Masculino , Recidiva Local de Neoplasia/diagnóstico , Neoplasias/complicações , Neoplasias/psicologia , Neoplasias/terapia , Segunda Neoplasia Primária/diagnóstico , Dor/etiologia , Disfunções Sexuais Fisiológicas/etiologia , Transtornos do Sono-Vigília/etiologia , Estresse Psicológico/etiologia
20.
Biomed Pharmacother ; 115: 108897, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31102913

RESUMO

Diabetes-induced male sexual dysfunction is associated with endothelial dysfunction. Inhibition of soluble epoxide hydrolase (sEH) is known to improve endothelial function in diabetes. Therefore, we hypothesized that sEH inhibitor (sEHI), [trans-4-{4-[3-(4-trifluoromethoxyphenyl)-ureido]cyclohexyloxy}benzoic acid] / t-TUCB can restore the male sexual function in diabetic rat. After one week of administration of diabetogenic agent STZ (52 mg/kg i.p) injection, diabetic rats were treated with t-TUCB (0.1 and 0.3 mg/kg, p.o) or vehicle for 8 weeks. The sexual behaviour parameters of the animals were evaluated at the end of dosing period. The levels of testosterone and glucose in serum, and sperm were quantified. Effect of treatment on weight of reproductive organs and histopathology of penile tissue was evaluated. Diabetes had a negative effect on male sexual function, weight of sexual organs and production of sperm with a parallel decrease in the level of testosterone. The sEHI, t-TUCB, significantly preserved the sexual function and minimized an increase in the level of blood glucose in diabetic rats. It also prevented a decrease in the level of testosterone and sperm in diabetic rats, in comparison to diabetic control rats. Further, diabetes induced distortion of corpus cavernosum was attenuated by t-TUCB. Based on our findings, sEHI may delay the development of sexual dysfunction in diabetes.


Assuntos
Benzoatos/farmacologia , Diabetes Mellitus Experimental/complicações , Diabetes Mellitus Experimental/tratamento farmacológico , Inibidores Enzimáticos/farmacologia , Epóxido Hidrolases/antagonistas & inibidores , Compostos de Fenilureia/farmacologia , Disfunções Sexuais Fisiológicas/prevenção & controle , Animais , Endotélio Vascular/efeitos dos fármacos , Genitália Masculina/efeitos dos fármacos , Genitália Masculina/patologia , Masculino , Músculo Liso Vascular/efeitos dos fármacos , Tamanho do Órgão/efeitos dos fármacos , Ratos Wistar , Comportamento Sexual Animal/efeitos dos fármacos , Disfunções Sexuais Fisiológicas/enzimologia , Disfunções Sexuais Fisiológicas/etiologia , Estreptozocina , Testosterona/sangue
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