Evaluation of sexual function and vaginal prolapse after radical cystectomy in women: a study to explore an under-evaluated problem

• Published in: International Urogynecology Journal Vol. 34; no. 12; pp. 2933 - 2943
• Main Authors: Wenk, Maren Juliane, Westhoff, N., Liedl, B., Michel, M. S., Grüne, B., Kriegmair, M. C.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.12.2023; Springer Nature B.V
• Subjects: Cystectomy - adverse effects; Female; Gynecology; Humans; Medicine; Medicine & Public Health; Original; Original Article; Pelvic organ prolapse; Pelvic Organ Prolapse - diagnosis; Pelvic Organ Prolapse - surgery; Quality of Life; Questionnaires; Sexual Behavior; Surveys and Questionnaires; Treatment Outcome; Urinary Incontinence - surgery; Urological surgery; Urology; Uterine Prolapse; Vagina; Vagina - surgery; Female sexual function; Radical cystectomy in women; Sexual activity; Vaginal prolapse; Patient-reported outcome measures; Quality of life
• ISSN: 0937-3462; 1433-3023
• DOI: 10.1007/s00192-023-05611-4

Introduction and hypothesis The objective was to evaluate sexual function, vaginal prolapse, and quality of life (QoL) in women after radical cystectomy (RC) using validated questionnaires and pelvic organ prolapse quantification (POP-Q) measurement. Methods Female bladder cancer patients who underwent RC at our tertiary care center were included (January 2008 to March 2022). Patients received three validated questionnaires (International Consultation on Incontinence Questionnaire Vaginal Symptoms [ICIQ-VS] Part A, Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire IUGA revised [PISQ], European Organization for Research and Treatment of Cancer Quality of Life Questionnaire [EORTC] C30/BLM30). Patients who consented were examined with vaginal POP-Q measurement. Results Out of 322 patients, 193 were still alive, 54 patients were lost to follow-up, and 43 were excluded, resulting in 96 patients who received the questionnaire. Finally, 35 patients were included, of whom 17 patients consented to vaginal examination. Complaints due to vaginal symptoms were low (ICIQ-VS 6.17 + 5.37). Sexual activity was reported by 12 patients (34.3%); 23 patients (65.71%) were not sexually active. No apical prolapse was found in POP-Q measurement; 6 patients (35.3%) had anterior, and 14 patients (82.4%) posterior prolapse; the highest prolapse stage was 2. No significant differences were found regarding POP stages, sexual function, and QoL (all p  > 0.05) when comparing continent and incontinent urinary diversions. Comparing the vaginal approach (no sparing vs sparing), significant differences were found in only two PISQ subscales (significantly higher scores after vagina sparing, p  = 0.01 and p  = 0.02). Conclusions The type of urinary diversion, POP-Q stages, and tumor stages did not show significant differences regarding sexual function, QoL, and prolapse complaints in women after RC, whereas a vagina- sparing approach showed significant differences only in two subscales without clinical relevance.