Sexual Function After Surgery for Prostate or Bladder Cancer

Strategies to prevent or minimize sexual dysfunction in patients following surgical therapy for prostate or bladder cancer are reviewed.

Abstract and Introduction

Abstract

Background: Compromised sexual function is often a side effect for patients following radical surgical procedures for bladder or prostate cancer.
Methods:The authors review the classification and physiology of sexual function and dysfunction. Moreover, they explain the possible pathophysiology directly resulting from surgery, and they discuss several approaches available to address these problems.
Results: Options for male sexual dysfunction, primarily erectile dysfunction resulting from radical prostatectomy or surgery for bladder cancer, range from patient education to penile prosthesis implantation. Female sexual dysfunction caused by surgical intervention for bladder cancer includes problems with libido, arousal, orgasm, and dyspareunia. Treatment options for women can include sex therapy, hormonal therapy, and preventive strategies.. However, no consensus has been established on the most effective agents and time points to treat male or female sexual dysfunction following radical cystectomies or prostatectomies.The chronic intermittent treatment of erectile dysfunction following radical prostatectomy has been commonly referred to as penile rehabilitation.
Conclusions: Additional research is needed to obtain further data concerning sexual dysfunction in both men and women following radical pelvic surgeries.Modification of surgical techniques, the use of various treatment modalities for sexual dysfunction, and the development of new agents will help to successfully minimize or prevent damage and restore normal sexual function after local surgical therapy for prostate or bladder cancer in the future.

Introduction

Sexual dysfunction is characterized by disturbances in sexual desire and in the psychophysiologic changes associated with the sexual response cycle. Phases of this cycle - excitement, plateau, orgasm, and resolution — correspond to observable physiologic changes in men and women and have been used to define sexual dysfunction diagnoses according to the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-IV) and the World Health Organization's consensus conferences.^[1,2]

In general,the most common form of sexual dysfunction in men is premature ejaculation. Male erectile dysfunction is the second most common entity and is defined as the inability to achieve or maintain a penile erection sufficient for satisfactory sexual performance.^[3] This condition affects an estimated 30 million men in the United States and approximately 152 million men worldwide.^[4] The etiology can be psychogenic, but organic causes predominate. Multiple risk factors,comorbidities, and iatrogenic causes are included in Table 1 .

Despite perceptions that sexual dysfunction is a male-predominant condition, more women than men report some compromise in their sexual performance (43% and 31%, respectively).^[5] Research in the field of female sexual function and dysfunction has increased. Female sexual dysfunction is a complex spectrum caused by disturbances in the normal sexual response cycle. Components affecting this cycle include anatomic, physiologic, psychologic, and social factors. The prevalence of female sexual dysfunction is approximately 42% in premenopausal women and 88% in postmenopausal women.^[6] Common complaints include diminished vaginal lubrication, pain and discomfort during sexual intercourse, decreased arousal, and difficulty achieving orgasm.

In general, any malignancy affecting the pelvis — from either the primary cancer or the required treatment — can eventually lead to sexual dysfunction. Gynecologic, gastrointestinal, and urologic malignancies can cause problems. Quality of life is an important component of multimodal treatment for cancer. Moreover, sexual function, being a critical quality-of-life predictor, has become an integral factor of this evaluation.

Prostate cancer is the leading cancer diagnosis in men and the third most common cause of cancer-related death in men in the United States.^[7] The lifetime risk of developing prostate cancer is 19% in the United States. Risk factors include older age, family history, race and ethnicity, and possibly dietary fat,^[8] but the etiology of this cancer remains unknown. With the widespread use of prostate-specific antigen testing and digital rectal examination as screening tools, the incidence of prostate cancer in the United States has increased.

Bladder cancer, the fifth most common cancer in the United States,^[7] typically presents as a superficial transitional cell carcinoma that is easily resectable endoscopically. However, local recurrence rates are high (66% at 5 years and 88% at 15 years), and between 10% to 30% progress to invasive cancer.^[9,10] Therapeutic options include surgery, radiation, and chemotherapy, but muscle-invasive bladder cancer typically necessitates radical cystectomy with urinary diversion.^[11]

This review describes changes in patients' sexual function after local surgical therapy for prostate or bladder cancer and discusses strategies to prevent or minimize sexual dysfunction in these patients.

Cancer Control. 2006;13(3):179-187. © 2006  H. Lee Moffitt Cancer Center and Research Institute, Inc.

Cite this: Sexual Function After Surgery for Prostate or Bladder Cancer - Medscape - Jul 01, 2006.