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1.
BMC Urol ; 19(1): 75, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31382934

RESUMO

BACKGROUND: Total Mesorectal Excision (TME) is the standard surgical technique for the treatment of rectal cancer. However, rates of sexual dysfunction ofup to 50% have been described after TME, and rates of urinary dysfunction of up to 30%. Although other factors are involved, the main cause of postoperative genitourinary dysfunction is intraoperative injury to the pelvic autonomic nerves. The risk is particularly high in the inferior mesenteric artery (IMA). The aim of this study is to compare pre- and post-TME sexual dysfunction, depending on the surgical approach usedin the inferior mesenteric vessels: either directly on the IMA, or from the inferior mesenteric vein (IMV) to the IMA. METHODS: Prospective, randomized,controlled study of patients with rectal adenocarcinoma with neoadjuvant chemoradiotherapy, who will be randomly assigned to one of two groups depending on the surgical approach to the inferior mesenteric vessels. The main variable is pre- and postoperative sexual dysfunction; secondary variables are visualization and preservation of the pelvic autonomic nerves, pre- and postoperative urinary dysfunction, and pre- and postoperative quality of life. The sample will comprise 90 patients, 45 per group. DISCUSSION: The aim is to demonstrate that the dissection route from the IMV towards the IMA favors the preservation of the pelvic autonomic nerves and thus reducesrates of sexual dysfunction post-surgery. TRIAL REGISTRATION: Ethical and Clinical Research Committee, Parc Taulí University Hospital: ID 017/315. ClinicalTrials.gov TAU-RECTALNERV-PRESERV-2018 (TRN: NCT03520088 ) (Date of registration 04/03/2018).


Assuntos
Adenocarcinoma/cirurgia , Laparoscopia , Artéria Mesentérica Inferior , Veias Mesentéricas , Complicações Pós-Operatórias/prevenção & controle , Neoplasias Retais/cirurgia , Disfunções Sexuais Fisiológicas/prevenção & controle , Adulto , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Humanos , Masculino , Estudos Prospectivos
2.
Presse Med ; 48(11 Pt 1): 1222-1228, 2019 Nov.
Artigo em Francês | MEDLINE | ID: mdl-31303372

RESUMO

Erectile dysfunction (ED) is not routinely discussed with patients in cardiology practices whereas it may impact the ability of patients to stay on therapy. Most of the studies about ED and antihypertensive therapies have several methodological limitations. Diuretics and beta-blockers have been shown to have a deleterious effect on ED. ISRA inhibitors, calcium antagonists, vasodilator beta-blockers and alpha-blockers have been shown to have a neutral impact on ED. Angiotensin 2 inhibitors, nebivolol and alpha-blockers use has sometimes beneficial effect on ED. In case of ED due to antihypertensive treatment, drugs can be switched each other but careful attention in patients with a high cardiovascular risk is required.


Assuntos
Anti-Hipertensivos/efeitos adversos , Hipertensão/tratamento farmacológico , Disfunções Sexuais Fisiológicas/induzido quimicamente , Antagonistas de Receptores Adrenérgicos alfa 1/uso terapêutico , Antagonistas Adrenérgicos beta/efeitos adversos , Antagonistas Adrenérgicos beta/uso terapêutico , Bloqueadores do Receptor Tipo 2 de Angiotensina II/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Bloqueadores dos Canais de Cálcio/efeitos adversos , Bloqueadores dos Canais de Cálcio/uso terapêutico , Doenças Cardiovasculares/tratamento farmacológico , Diuréticos/efeitos adversos , Diuréticos/uso terapêutico , Substituição de Medicamentos , Humanos , Masculino , Antagonistas de Receptores de Mineralocorticoides/efeitos adversos , Fatores de Risco , Disfunções Sexuais Fisiológicas/prevenção & controle
3.
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
4.
Int J Dermatol ; 58(8): 982-986, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31099425

RESUMO

On July 25, 2017, we conducted an extensive database tracking to identify all studies published from January 1990 to July 2017. Screening updates were performed until December 2017. RESULTS: There were no deaths, and the resolution of symptoms of primary plantar hyperhidrosis (PPH) occurred in 92% of patients after mechanical sympathectomy. A total of 177 patients (44%) were reported to have mild to severe compensatory sweating after a mean 6 months follow-up. The preservation of L2 did not interfere with the primary outcome, and it is possible to perform lumbar sympathectomy in men with L2 preservation, achieving satisfactory cure results of PPH, minimizing the risk of sexual dysfunction. There were no deaths, and the resolution of symptoms of PPH occurred in 10% of patients after chemical sympathicolysis after a mean 6 months follow-up. A total of 13 patients (12.5%) were reported to have mild to severe compensatory sweating using the same technique. CONCLUSION: The mechanical lumbar sympathectomy is effective and safe and improves quality of life, evaluated by the high symptom resolution of PPH and low rate of complications. The chemical sympathicolysis in the immediate postoperative period presented satisfactory results; however, it was shown to be significantly less effective than the mechanical approach in a follow-up of at least 6 months.


Assuntos
Hiperidrose/terapia , Plexo Lombossacral/cirurgia , Complicações Pós-Operatórias/epidemiologia , Soluções Esclerosantes/administração & dosagem , Simpatectomia/métodos , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Feminino , , Humanos , Hiperidrose/diagnóstico , Hiperidrose/psicologia , Plexo Lombossacral/efeitos dos fármacos , Masculino , Tratamentos com Preservação do Órgão/efeitos adversos , Tratamentos com Preservação do Órgão/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Qualidade de Vida , Soluções Esclerosantes/efeitos adversos , Índice de Gravidade de Doença , Fatores Sexuais , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/prevenção & controle , Simpatectomia/efeitos adversos , Resultado do Tratamento
5.
Trials ; 20(1): 144, 2019 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-30786930

RESUMO

BACKGROUND: Sexual dysfunction can have a negative impact on women's quality of life and relationships. There is limited information about female sexual function and treatment, particularly during pregnancy and the postpartum period. The effect of pelvic floor muscle exercise (PFME) on sexual function (SF) has not been studied adequately. The purpose of this study is to investigate the effect of antenatal PFME on female SF during pregnancy and the first 3 months following birth. METHODS/DESIGN: This is a pragmatic, randomised controlled trial which will compare a structured antenatal PFME programme combined with standard antenatal care to standard antenatal care alone. Eligible women who are less than 22 weeks' gestation will be recruited from the antenatal clinics of one hospital located in Western Sydney, Australia. A sample of 200 primiparous pregnant women who meet the inclusion criteria will be randomised to either control or intervention groups. This sample size will allow for detecting a minimum difference of 9% in the female SF score between the two groups. The duration of the PFME programme is from approximately 20 weeks' gestation until birth. Female SF will be measured via questionnaires at < 22 weeks' gestation, at 36 weeks' gestation and at 3 months following birth. Baseline characteristics, such as partner relationship and mental health, will be collected using surveys and questionnaires. Data collected for secondary outcomes include the effect of PFME on childbirth outcomes, urinary and faecal incontinence symptoms and quality of life. DISCUSSION: The findings of this study will provide more information on whether a hospital-based antenatal PFME has any effect on female SF, urinary and faecal incontinence during pregnancy and the first 3 months following birth. The study will also provide information on the effectiveness of antenatal PFME on childbirth outcomes. TRIAL REGISTRATION: Australian New Zealand Clinical Trials registry, ACTRN12617001030369 . Registered on 17 July 2017.


Assuntos
Terapia por Exercício , Distúrbios do Assoalho Pélvico/prevenção & controle , Diafragma da Pelve/fisiopatologia , Complicações na Gravidez/prevenção & controle , Cuidado Pré-Natal/métodos , Comportamento Sexual , Disfunções Sexuais Fisiológicas/prevenção & controle , Feminino , Humanos , Contração Muscular , New South Wales , Distúrbios do Assoalho Pélvico/diagnóstico , Distúrbios do Assoalho Pélvico/etiologia , Distúrbios do Assoalho Pélvico/fisiopatologia , Período Pós-Parto , Ensaios Clínicos Pragmáticos como Assunto , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/etiologia , Complicações na Gravidez/fisiopatologia , Qualidade de Vida , Disfunções Sexuais Fisiológicas/diagnóstico , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
6.
Am J Ther ; 26(4): e433-e440, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29746287

RESUMO

BACKGROUND: Elevated prolactin levels were found to be associated with impaired sexuality. STUDY QUESTION: The aim of the study was to compare the impact of bromocriptine and cabergoline on sexual functioning in both genders. STUDY DESIGN: The study enrolled 39 young women and 18 young men receiving bromocriptine treatment. In 19 women and 8 men, because of poor tolerance, bromocriptine was replaced with cabergoline, whereas the remaining ones continued bromocriptine treatment. MEASURES AND OUTCOMES: Apart from measuring serum levels of prolactin and insulin sensitivity, at the beginning of the study and 16 weeks later, all included patients completed questionnaires evaluating female or male sexual functioning (Female Sexual Function Index; International Index of Erectile Function-15). RESULTS: Irrespective of the gender, posttreatment prolactin levels were lower in cabergoline-treated patients than in bromocriptine-treated patients. Baseline sexual functioning did not differ between patients well and poorly tolerating bromocriptine treatment. Neither in men nor in women receiving bromocriptine, posttreatment sexual functioning differed from baseline one. In both genders, cabergoline improved sexual desire. Moreover, in men, the drug improved erectile and orgasmic function, whereas in women, it improved sexual arousal. All these effects correlated with the impact of this drug on prolactin levels and on insulin sensitivity. CONCLUSIONS: Cabergoline is superior to bromocriptine in affecting male and female sexual functioning and should be preferred in hyperprolactinemic men and women with sexual dysfunction.


Assuntos
Bromocriptina/administração & dosagem , Cabergolina/administração & dosagem , Agonistas de Dopamina/administração & dosagem , Hiperprolactinemia/tratamento farmacológico , Disfunções Sexuais Fisiológicas/prevenção & controle , Adulto , Feminino , Humanos , Hiperprolactinemia/sangue , Hiperprolactinemia/complicações , Masculino , Pessoa de Meia-Idade , Orgasmo/efeitos dos fármacos , Orgasmo/fisiologia , Ereção Peniana/efeitos dos fármacos , Ereção Peniana/fisiologia , Prolactina/sangue , Prolactina/fisiologia , Disfunções Sexuais Fisiológicas/sangue , Disfunções Sexuais Fisiológicas/etiologia , Resultado do Tratamento , Adulto Jovem
7.
World J Urol ; 37(2): 299-308, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29967947

RESUMO

PURPOSE: Ejaculatory dysfunction is the most common side effect related to surgical treatment of benign prostatic obstruction (BPO). Nowadays, modified surgical techniques and non-ablative techniques have emerged with the aim of preserving antegrade ejaculation. Our objective was to conduce a systematic review of the literature regarding efficacy on ejaculatory preservation of modified endoscopic surgical techniques, and mini-invasive non-ablatives techniques for BPO management. METHODS: A systematic review of the literature was carried out on the PubMed database using the following MESH terms: "Prostatic Hyperplasia/surgery" and "Ejaculation", in combination with the following keywords: "ejaculation preservation", "photoselective vaporization of the prostate", "photoselective vapo-enucleation of the prostate", "holmium laser enucleation of the prostate", "thulium laser", "prostatic artery embolization", "urolift", "rezum", and "aquablation". RESULTS: The ejaculation preservation rate of modified-TURP ranged from 66 to 91%. The ejaculation preservation rate of modified-prostate photo-vaporization ranged from 87 to 96%. The only high level of evidence studies available compared prostatic urethral lift (PUL) and aquablation versus regular TURP in prospective randomized-controlled trials. The ejaculation preservation rate of either PUL or aquablation compared to regular TURP was 100 and 90 versus 34%, respectively. CONCLUSIONS: Non-ablative therapies and modified endoscopic surgical techniques seemed to be reasonable options for patients eager to preserve their ejaculatory functions.


Assuntos
Ejaculação , Hiperplasia Prostática/cirurgia , Disfunções Sexuais Fisiológicas/prevenção & controle , Ressecção Transuretral da Próstata/efeitos adversos , Obstrução do Colo da Bexiga Urinária/cirurgia , Transtornos Urinários/prevenção & controle , Técnicas de Ablação , Embolização Terapêutica , Endoscopia , Humanos , Terapia a Laser , Lasers de Estado Sólido/uso terapêutico , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos , Próstata/irrigação sanguínea , Próstata/cirurgia , Hiperplasia Prostática/complicações , Hiperplasia Prostática/terapia , Implantação de Prótese , Disfunções Sexuais Fisiológicas/etiologia , Vapor , Obstrução do Colo da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/terapia , Transtornos Urinários/etiologia
8.
Eur Urol ; 75(3): 492-497, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30553615

RESUMO

BACKGROUND: With the increasing adoption of novel technologies and anatomical techniques, surgical management of benign prostatic hyperplasia (BPH) provides significant benefits in terms of obstruction relief, early urethral catheter removal, and faster return to daily activities. However, the main pitfall of BPH surgery in sexually active men remains ejaculatory dysfunction (EjD), which permanently affects quality of life. OBJECTIVE: To detail a novel technique for marking the intraprostatic urethra through a retrograde injection of indocyanine green to enhance selective dissection of prostatic lobes during urethra-sparing robot-assisted simple prostatectomy (US-RASP) with the use of near-infrared fluorescence imaging (NIFI). DESIGN, SETTING, AND PARTICIPANTS: Between January and September 2017, 12 consecutive male patients, who had BPH, were sexually active, and were motivated to preserve ejaculatory function, underwent US-RASP. SURGICAL PROCEDURE: US-RASP with NIFI to enhance the identification and preservation of the prostatic urethra. MEASUREMENTS: Clinical data were prospectively collected in our institutional RASP dataset. Perioperative and functional outcomes of US-RASP were both graded, and assessed according to Clavien grading system and validated questionnaires postoperatively (International Prostate Symptom Score [IPSS]; Male Sexual Health Questionnaire on EjD [MSHQ-EjD] Short Form) at 3 and 12mo. RESULTS AND LIMITATIONS: Median preoperative prostate size was 102cc (interquartile range [IQR] 88-115). Median operative time was 150min (IQR 145-170). Median estimated blood loss was 250 (IQR 200-350). Continuous bladder irrigation was avoided in 83.4% of patients. Median time to catheter removal was 7d (IQR 7-7) with a median hospital stay of 3d (IQR 2-3). At 1-yr follow-up, median IPSS score, International Index of Erectile Function score, and MSHQ-EjD Short Form score were 5 (IQR 4-8), 26 (IQR 26-28), and 12 (IQR 1-14), respectively. Satisfactory anterograde ejaculation was reported in eight patients (66%). CONCLUSIONS: We described a novel NIFI-guided technique to perform US-RASP. This technique showed promising early functional results, suggesting a significant role of intraprostatic urethral integrity for the preservation of ejaculatory function. PATIENT SUMMARY: We developed a novel robotic technique to perform simple prostatectomy with integral preservation of the prostatic urethra. This technique provided a high rate of ejaculatory function preservation.


Assuntos
Ejaculação , Corantes Fluorescentes/administração & dosagem , Verde de Indocianina/administração & dosagem , Imagem Óptica/métodos , Prostatectomia/métodos , Hiperplasia Prostática/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Uretra/cirurgia , Humanos , Tempo de Internação , Masculino , Imagem Óptica/efeitos adversos , Tratamentos com Preservação do Órgão , Prostatectomia/efeitos adversos , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/fisiopatologia , Qualidade de Vida , Recuperação de Função Fisiológica , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Comportamento Sexual , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/fisiopatologia , Disfunções Sexuais Fisiológicas/prevenção & controle , Fatores de Tempo , Resultado do Tratamento , Uretra/fisiopatologia
9.
Int J Dermatol ; 58(7): 777-781, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30315576

RESUMO

Balanitis xerotica obliterans (BXO), or penile lichen sclerosus, is a progressive sclerosing inflammatory dermatosis of the glans penis and foreskin. It is associated with significant morbidity and may result in impaired urinary and sexual function. It was initially described by Stuhmer in 1928, named after its pathological features, and is considered the male equivalent of vulvar lichen sclerosis (LS).3,40 The etiology of BXO is uncertain; however, autoimmune disease, local trauma, and genetic and infective causes have been proposed. BXO occurs most commonly on the prepuce and glans penis. It is considered to have premalignant potential to transform into squamous neoplasia. This postulation rests on retrospective studies and parallels drawn with vulvar LS and squamous cell carcinoma (SCC) development. Histologically, BXO and vulvar LS are considered the same disease.41 There is a paucity of evidence-based guidelines to assist with appropriate follow-up for patients with BXO.


Assuntos
Balanite Xerótica Obliterante/terapia , Circuncisão Masculina , Glucocorticoides/administração & dosagem , Pênis/patologia , Lesões Pré-Cancerosas/terapia , Administração Tópica , Balanite Xerótica Obliterante/complicações , Balanite Xerótica Obliterante/diagnóstico , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/prevenção & controle , Dermatologia/métodos , Dermatologia/normas , Diagnóstico Diferencial , Humanos , Masculino , Neoplasias Penianas/patologia , Neoplasias Penianas/prevenção & controle , Fimose/etiologia , Fimose/cirurgia , Guias de Prática Clínica como Assunto , Lesões Pré-Cancerosas/complicações , Lesões Pré-Cancerosas/diagnóstico , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/prevenção & controle , Transtornos Urinários/etiologia , Transtornos Urinários/prevenção & controle
10.
J Sex Med ; 15(12): 1792-1810, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30539735

RESUMO

BACKGROUND: There are multiple treatment options for men with localized prostate cancer that provide similar curative efficacy but differ in their impact on sexual functioning. AIM: To evaluate the psychometric properties of the Patient-Reported Outcomes Measurement Information System (PROMIS) Sexual Function and Satisfaction (SexFS) measures, including items from versions 1 and 2 of the short forms. METHODS: A population-based cohort of men across North Carolina completed surveys via phone interviews at baseline (prior to treatment) and at 3, 12, and 24 months after cancer treatment initiation. Surveys included the PROMIS SexFS domains of interest in sexual activity, erectile function, orgasm, and satisfaction and the Prostate Cancer Symptom Indices. Analyses included descriptive statistics, assessment of structural validity using confirmatory factor analysis and item response theory, tests for differential item functioning, assessment of convergent validity using correlations, and evaluation of responsiveness of the PROMIS SexFS measures over time. We hypothesized that men undergoing surgery (prostatectomy) would report the poorest sexual function at the 3-month survey. RESULTS: Sample size varied by assessment point and ranged from 332‒939 men, consisting of 30% non-white men, and 30% of the sample had a high school degree or less. The items within the PROMIS orgasm domain did not form a unidimensional scale. PROMIS measures of interest in sexual activity, erectile function, and satisfaction were unidimensional and highly correlated with related Prostate Cancer Symptom Indices measures (eg, erectile function, r = 0.84‒0.95). Erectile function in the surgery group declined more at 3 months compared to the no-surgery group (2 points); this difference narrowed at 12 and 24 months after surgery, as the surgery group recovered over time. Results were similar for PROMIS Interest in Sexual Activity and PROMIS Satisfaction scales. CLINICAL IMPLICATIONS: The PROMIS SexFS measures may be used to identify effective interventions to treat sexual dysfunction and monitor sexual functioning in men with prostate cancer over time. STRENGTH & LIMITATIONS: This study was limited to men living in North Carolina who could self-report their health-related quality of life in English. However, this study was able to include more men from vulnerable populations by allowing them to self-report over the phone. CONCLUSION: This study provided strong support for use of the PROMIS SexFS (version 2) measures in men with localized prostate cancer to assess sexual interest, erectile function, and satisfaction over time. Reeve BB, Wang M, Weinfurt K, et al. Psychometric Evaluation of PROMIS Sexual Function and Satisfaction Measures in a Longitudinal Population-Based Cohort of Men With Localized Prostate Cancer. J Sex Med 2018;15:1792-1810.


Assuntos
Satisfação Pessoal , Disfunções Sexuais Fisiológicas/diagnóstico , Inquéritos e Questionários/normas , Estudos de Coortes , Humanos , Masculino , Pessoa de Meia-Idade , North Carolina , Ereção Peniana , Neoplasias da Próstata/cirurgia , Psicometria/métodos , Reprodutibilidade dos Testes , Autorrelato , Disfunções Sexuais Fisiológicas/prevenção & controle , Disfunções Sexuais Fisiológicas/cirurgia
11.
World J Surg Oncol ; 16(1): 196, 2018 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-30285780

RESUMO

BACKGROUND: Urogenital dysfunction after rectal cancer surgery can largely affect patients' postoperative quality of life. Whether robotic surgery can be a better option when comparing with laparoscopic surgery is still not well-known. METHODS: Comprehensive search in PubMed, Embase, Cochrane Library, and Clinical Trials was conducted to identify relevant studies in March 2018. Studies comparing robotic surgery with laparoscopic surgery were included. Measurement of urogenital function was through the International Prostate Symptom Score and International Index of Erectile Function. RESULTS: Six studies with 386 patients in robotic group and 421 patients in laparoscopic group were finally included. Pooled analysis indicated that bladder function was better at 12 months in the robotic group after the procedures (mean difference, - 0.30, 95% CI, - 0.52 to - 0.08). No significant difference was found at 3 and 6 months postoperatively (mean difference, - 0.37, 95% CI, - 1.48 to 0.73; mean difference, - 1.21, 95% CI, - 2.69 to 0.28). Sexual function was better at 3 months in the robotic group after surgery (mean difference, - 3.28, 95% CI, - 6.08 to - 0.49) and not significantly different at 6 and 12 months. (mean difference, 3.78, 95% CI, - 7.37 to 14.93; mean difference, - 2.82, 95% CI, - 8.43 to 2.80). CONCLUSION: Robotic surgery may offer faster recovery in urogenital function compared to laparoscopic surgery for rectal cancer.


Assuntos
Laparoscopia/métodos , Complicações Pós-Operatórias , Qualidade de Vida , Recuperação de Função Fisiológica , Neoplasias Retais/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Disfunções Sexuais Fisiológicas/prevenção & controle , Humanos , Masculino , Prognóstico , Transtornos Urinários/prevenção & controle
12.
Nurse Pract ; 43(11): 39-45, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30256272

RESUMO

Although diabetic autonomic neuropathy (DAN), a complication associated with diabetes, is increasing in prevalence, it is often overlooked. Knowledge regarding the development and progression of this complication is limited. NPs are in a key position to prevent complications of DAN, including sexual dysfunction, in this vulnerable population.


Assuntos
Neuropatias Diabéticas/complicações , Neuropatias Diabéticas/enfermagem , Disfunções Sexuais Fisiológicas/etiologia , Neuropatias Diabéticas/fisiopatologia , Humanos , Profissionais de Enfermagem , Diagnóstico de Enfermagem , Disfunções Sexuais Fisiológicas/prevenção & controle
14.
Urol Clin North Am ; 45(2): 249-256, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29650140

RESUMO

Approximately 1 in 5 new cases of clinically localized bladder cancer is muscle invasive and requires the patient to choose from 1 of 2 prevailing options for treatment: radical cystectomy or radiation to the bladder. However, these treatments are associated with detrimental effects on patient well-being and quality of life, particularly with respect to functional independence, urinary and sexual function, social and emotional health, body image, and psychosocial stress. Compared with the literature on other malignancies like breast or prostate cancer, high-quality studies evaluating the effects of bladder cancer treatment on quality of life are lacking.


Assuntos
Cistectomia , Qualidade de Vida , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária , Cistectomia/efeitos adversos , Cistectomia/métodos , Feminino , Genitália Feminina/inervação , Genitália Masculina/inervação , Humanos , Masculino , Tratamentos com Preservação do Órgão , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/prevenção & controle , Derivação Urinária/efeitos adversos
15.
Curr Med Res Opin ; 34(9): 1579-1586, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29508635

RESUMO

Objective Even mild hypothyroidism in pre-menopausal women is accompanied by impaired sexual functioning. The study was aimed at comparing the effect of levothyroxine, administered alone or in combination with liothyronine, on sexual function and depressive symptoms in pre-menopausal women treated because of hypothyroidism. Methods This quasi-randomized, single-blind study included 39 young women receiving levothyroxine treatment who, despite thyrotropin and thyroid hormone levels within normal limits, still experienced clinical symptoms of hypothyroidism. These patients were divided into two groups: group A (n = 20) continued levothyroxine treatment, while group B (n = 19) received levothyroxine/liothyronine combination therapy. At the beginning of the study, and 6 months later, all participants of the study filled in questionnaires evaluating female sexual functioning (Female Sexual Function Index; FSFI) and the presence and severity of depressive symptoms (Beck Depression Inventory-Second Edition; BDI-II). Results The study was completed by 37 women. Baseline sexual functioning and depressive symptoms did not differ between the study groups. Neither the total FSFI score nor the domain scores changed throughout the study in women who continued levothyroxine treatment. Compared to levothyroxine administered alone, levothyroxine/liothyronine combination therapy increased scores for two domains: sexual desire and arousal, tended to increase the total FSFI score, as well as tended to decrease the overall BDI-II score. The effect of the combination therapy on sexual function correlated with a treatment-induced increase in serum levels of free triiodothyronine and testosterone. Conclusions The obtained results suggest that levothyroxine administered together with liothyronine is superior to levothyroxine administered alone in affecting female sexual functioning.


Assuntos
Depressão , Hipotireoidismo , Disfunções Sexuais Fisiológicas , Tiroxina , Tri-Iodotironina , Adulto , Depressão/diagnóstico , Depressão/etiologia , Depressão/prevenção & controle , Feminino , Humanos , Hipotireoidismo/sangue , Hipotireoidismo/complicações , Hipotireoidismo/tratamento farmacológico , Conduta do Tratamento Medicamentoso/estatística & dados numéricos , Pessoa de Meia-Idade , Projetos Piloto , Escalas de Graduação Psiquiátrica , Disfunções Sexuais Fisiológicas/diagnóstico , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/prevenção & controle , Método Simples-Cego , Inquéritos e Questionários , Hormônios Tireóideos/administração & dosagem , Hormônios Tireóideos/efeitos adversos , Hormônios Tireóideos/sangue , Tiroxina/administração & dosagem , Tiroxina/efeitos adversos , Resultado do Tratamento , Tri-Iodotironina/administração & dosagem , Tri-Iodotironina/efeitos adversos
16.
Female Pelvic Med Reconstr Surg ; 24(2): 142-149, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29474288

RESUMO

OBJECTIVES: Pelvic floor muscle training (PFMT) is often recommended to treat postpartum urinary incontinence (UI). However, the role of postpartum PFMT in pelvic organ prolapse (POP), sexual function, and anal incontinence (AI) remains unclear. We therefore aim to assess the efficacy of postpartum PFMT on these pelvic floor disorders. METHODS: This study is a meta-analysis consisting of randomized controlled trials (RCTs). We searched databases including CENTRAL, MEDLINE, EMBASE, CINAHL, and PEDro. We also sought after grey literature including conference proceedings. We included RCTs comparing PFMT versus watchful waiting in women with stage II or less POP within 1 year postpartum. Two authors independently performed study screening, risk of bias assessments, and data extraction. RESULTS: Fifteen RCTs (3845 patients) were included. Women undergoing PFMT less likely report bothersome POP symptoms (risk ratio [RR], 0.48 [0.30-0.76]; very low-quality evidence). There is no significant difference in the number of women with stage II or greater POP (RR, 0.74 [0.45-1.24]; moderate-quality evidence). Fewer women receiving PFMT report the presence of sexual dysfunction (RR, 0.48 [0.30-0.77]; low-quality evidence). There is no significant difference in AI symptoms (RR, 1.11 [0.82-1.51]), but PFMT may be more beneficial for women with anal sphincter injuries (standardized mean differencein AI scores, -0.57 [-1.12 to -0.02]; low-quality evidence). Women receiving PFMT less likely report UI (RR, 0.44 [0.25-0.75]; moderate-quality evidence) with a more pronounced effect on stress UI (SUI). CONCLUSIONS: At present, it remains uncertain whether postpartum PFMT improves POP symptoms because of very low-quality evidence, and more high-quality RCTs are needed in this area. The POP staging will likely not change with postpartum PFMT. The PFMT may result in improved postpartum sexual function compared to watchful waiting, and may provide benefit for AI in women with anal sphincter injuries. Postpartum PFMT likely reduces the risk of UI, particularly stress urinary incontinence symptoms. There is currently little evidence about postpartum PFMT and long-term pelvic floor function.


Assuntos
Terapia por Exercício/métodos , Distúrbios do Assoalho Pélvico/terapia , Cuidado Pós-Natal/métodos , Conduta Expectante , Incontinência Fecal/prevenção & controle , Feminino , Humanos , Contração Muscular/fisiologia , Satisfação do Paciente , Diafragma da Pelve/fisiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Disfunções Sexuais Fisiológicas/prevenção & controle , Resultado do Tratamento , Incontinência Urinária/prevenção & controle
17.
Sex Med Rev ; 6(3): 469-481, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29371143

RESUMO

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.


Assuntos
Cistectomia/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Disfunções Sexuais Fisiológicas , Feminino , Humanos , Masculino , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/prevenção & controle
18.
Gynecol Endocrinol ; 34(2): 110-114, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28749253

RESUMO

The aim of the study was to verify the efficacy of vulvar Visnadine spray in premenopausal women affected by female sexual arousal disorder (FSAD). Thirty-eight women aged 25-40 years affected by FSAD were enrolled in the randomized crossover study, by two possible sequences: on-demand, washout, daily (A sequence); and daily, washout, on-demand (B sequence). The Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS) were used to assess sexual function and sexual distress, respectively. Color Doppler ultrasonography was used to measure clitoral blood flow. The study had two follow-ups at 30 (T1) and 60 days (T2). Thirty-one women completed the study. Mean (SD) sexual activity and vulvar Visnadine spray usage was 1 ± 0.9 weekly during on-demand administration for both the sequences (Vs T0, p = NS). The mean sexual activity during daily usage was 2 ± 0.9 (Vs T0, p < .004) and 2 ± 0.8 (Vs T0, p < .001) for A and B sequences, respectively. FSFI total score, particularly genital arousal, improved more during the daily than during on-demand phases of both sequences (p < .001). Finally, clitoral blood flow improved significantly during daily usage of both the sequences (p < .001). Our study suggests that vulvar Visnadine spray could improve sexual performance of women affected by FSAD, producing changes in subjective and objective sexual aspects.


Assuntos
Cromanos/uso terapêutico , Disfunções Sexuais Fisiológicas/prevenção & controle , Vagina/efeitos dos fármacos , Doenças Vaginais/tratamento farmacológico , Vasodilatadores/uso terapêutico , Vulva/efeitos dos fármacos , Doenças da Vulva/tratamento farmacológico , Administração Cutânea , Administração através da Mucosa , Adulto , Aerossóis , Cromanos/administração & dosagem , Clitóris/irrigação sanguínea , Clitóris/efeitos dos fármacos , Clitóris/fisiopatologia , Clitóris/cirurgia , Estudos Cross-Over , Manual Diagnóstico e Estatístico de Transtornos Mentais , Esquema de Medicação , Feminino , Seguimentos , Humanos , Pacientes Desistentes do Tratamento , Escalas de Graduação Psiquiátrica , Fluxo Sanguíneo Regional/efeitos dos fármacos , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/psicologia , Estresse Psicológico/etiologia , Estresse Psicológico/prevenção & controle , Ultrassonografia Doppler em Cores , Vagina/irrigação sanguínea , Vagina/metabolismo , Vagina/fisiopatologia , Doenças Vaginais/diagnóstico por imagem , Doenças Vaginais/fisiopatologia , Vasodilatadores/administração & dosagem , Vulva/irrigação sanguínea , Vulva/metabolismo , Vulva/fisiopatologia , Doenças da Vulva/diagnóstico por imagem , Doenças da Vulva/fisiopatologia
20.
Semin Pediatr Surg ; 26(5): 336-342, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29110831

RESUMO

Anorectal malformations are an important group of congenital anomalies that vary widely in their anatomical characteristics and complexity. Understanding the long-term functional outcomes after modern treatments, and how these compare to the general population, are essential for ensuring that patients receive optimal, evidence-based care. With increasing appreciation of the wider impact of the illness on patients and their families, minimizing social disability from fecal incontinence and enabling normal social integration from the outset are key management concerns. This review summarizes the current knowledge on the functional outcomes by type of malformation, reflecting on the literature, and our institutional experience over a follow-up period of nearly 30 years.


Assuntos
Malformações Anorretais/cirurgia , Constipação Intestinal/prevenção & controle , Incontinência Fecal/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Qualidade de Vida , Disfunções Sexuais Fisiológicas/prevenção & controle , Canal Anal/cirurgia , Malformações Anorretais/fisiopatologia , Constipação Intestinal/etiologia , Incontinência Fecal/etiologia , Humanos , Complicações Pós-Operatórias/etiologia , Reto/cirurgia , Disfunções Sexuais Fisiológicas/etiologia , Resultado do Tratamento
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