Le couple face aux difficultés sexuelles liées aux troubles urinaires

Lower urinary tract symptoms are frequent in both men and women and group several entities, the most frequent of which is bladder hyperactivity with or without incontinence, benign prostatic hyperplasia, painful urinary disorders, stress incontinence, and recurrent urinary infections. Bladder hyperactivity is said to be present in 17% of women and 15% of men over 40 years of age. In the past 10 years, studies have shown that these problems interfere with the quality of life of most patients and were particularly associated with sexual dysfunctions. In bladder hyperactivity, nearly one woman in two has a sexual disorder (mainly pain or libido disorders); in men, significantly more Bladder hyperactivity erectile or ejaculatory dysfunction is noted. These diseases have benefitted from notable Sexual dysfunction therapeutic progress. Given the frequency of urinary disorders, their repercussions on Couple male and female sexuality, and the existence of effective treatments, it is indispensable Global approach to think of screening for them within a coherent and global approach to couples seeking treatment for sexual dysfunction.     

Sexual Functioning After Treatment for Early Stage Prostate Cancer

With recent advances in prostate cancer detection and treatment, the vast majority of men with newly diagnosed prostate cancer can expect long-term survival. Therefore, quality of life issues become important in selecting the appropriate therapeutic approach. Sexual function can be adversely affected by the only available curative treatment modalities: radical prostatectomy, external beam radiation therapy and interstitial brachytherapy. The pathophysiology of erectile dysfunction after surgery and radiation therapy are reviewed. Reports documenting rates of erectile dysfunction after treatment among men potent prior to treatment are described. Management options for patients who become impotent after surgery or radiation therapy are outlined. Future avenues of research to decrease the rates of potency loss with modern treatment techniques are suggested.     

中国10个地区中老年人尿失禁的描述性分析

目的 描述中国10个地区中老年人尿失禁患病率的人群和地区分布特征。方法 对完成中国慢性病前瞻性研究项目2020-2021年第三次重复调查的24 913名45~95岁的研究对象进行分析。通过调查员面对面询问了解研究对象发生尿失禁的情况，进一步区分单纯压力性尿失禁、单纯急迫性尿失禁和混合性尿失禁。分性别、年龄、地区等特征报告尿失禁及其亚型的患病率，并描述患者严重程度和接受治疗情况。结果 研究对象年龄为（65.4±9.1）岁。以2020年第七次全国人口普查数据进行年龄标化后，女性自报尿失禁标化患病率为25.4%，男性为7.0%。男性中单纯压力性尿失禁、单纯急迫性尿失禁和混合性尿失禁的标化患病率依次为1.7%、4.2%和1.2%，女性中对应的标化患病率依次为13.5%、5.8%和6.1%。男性尿失禁及各种亚型的患病率、女性尿失禁及除单纯压力性尿失禁以外的各亚型患病率均随年龄增长而升高（P<0.001）。调整年龄后，农村男、女性尿失禁患病率均高于城市（P<0.001）。男性和女性尿失禁患者自报接受治疗率分别为15.4%和8.5%。结论 我国中老年人群的尿失禁患病率较高，且女性高于男性，而尿失禁患者的治疗率较低。     

Definitive radiotherapy for primary vaginal cancer: correlation between treatment patterns and recurrence rate

The purpose of this study was to determine the outcomes and optimal practice patterns of definitive radiotherapy for primary vaginal cancer. Between 1993 and 2012, 49 patients were treated with definitive radiotherapy for primary vaginal cancer in three hospitals. Of these, 15 patients (31%) had clinically positive regional lymph node metastasis. A total of 34 patients (70%) received external beam radiotherapy with high-dose-rate brachytherapy (interstitial or intracavitary), and 8 (16%) (with small superficial Stage I tumors) were treated with local radiotherapy. The median follow-up was 33 months (range: 1–169 months). The 3-year overall survival (OS), disease-free survival (DFS), and loco-regional control (LRC) rates were 83%, 59% and 71%, respectively. In multivariate analysis, the histological type (P = 0.044) was significant risk factors for LRC. In Federation of Gynecology and Obstetrics (FIGO) Stage I cases, 3 of 8 patients (38%) who did not undergo prophylactic lymph node irradiation had lymph node recurrence, compared with 2 of 12 patients (17%) who underwent prophylactic pelvic irradiation. For Stage III–IV tumors, the local recurrence rate was 50% and the lymph node recurrence rate was 40%. Patients with FIGO Stage I/II or clinical Stage N1 had a higher recurrence rate with treatment using a single modality compared with the recurrence rate using combined modalities. In conclusion, our treatment outcomes for vaginal cancer were acceptable, but external beam radiotherapy with brachytherapy (interstitial or intracavitary) was needed regardless of FIGO stage. Improvement of treatment outcomes in cases of FIGO Stage III or IV remains a significant challenge.     

Erectile Dysfunction and Undiagnosed Diabetes,Hypertension, and Hypercholesterolemia

PURPOSEWe investigated whether erectile dysfunction, a marker for future cardiovascular disease, is associated with undiagnosed cardiometabolic risk factors among US men. Identifying the presence of these risk factors could lead to earlier initiation of treatment for primary prevention of cardiovascular disease.METHODSWe analyzed cross-sectional data from men aged 20 years and older who participated in the National Health and Nutrition Examination Survey during 2001–2004. Erectile dysfunction was determined by a single, validated survey question. We used logistic regression analyses to investigate the relationship between erectile dysfunction and undiagnosed hypertension, hypercholesterolemia, and diabetes.RESULTSAfter multivariate adjustment, men with erectile dysfunction had more than double the odds of having undiagnosed diabetes (odds ratio = 2.20; 95% CI, 1.10–4.37), whereas no association was seen for undiagnosed hypertension or undiagnosed hypercholesterolemia. For the average man aged 40 to 59 years, the predicted probability of having undiagnosed diabetes increased from 1 in 50 in the absence of erectile dysfunction to 1 in 10 in the presence of erectile dysfunction.CONCLUSIONSOur results underscore the importance of erectile dysfunction as a marker of undiagnosed diabetes. Erectile dysfunction should be a trigger to initiate diabetes screening, particularly among middle-aged men.     

Physician Social Networks and Variation in Rates of Complications After Radical Prostatectomy

ObjectivesVariation in care within and across geographic areas remains poorly understood. The goal of this article was to examine whether physician social networks—as defined by shared patients—are associated with rates of complications after radical prostatectomy.MethodsIn five cities, we constructed networks of physicians on the basis of their shared patients in 2004-2005 Surveillance, Epidemiology and End Results-Medicare data. From these networks, we identified subgroups of urologists who most frequently shared patients with one another. Among men with localized prostate cancer who underwent radical prostatectomy, we used multilevel analysis with generalized linear mixed-effect models to examine whether physician network structure—along with specific characteristics of the network subgroups—was associated with rates of 30-day and late urinary complications, and long-term incontinence after accounting for patient-level sociodemographic, clinical factors, and urologist patient volume.ResultsNetworks included 2677 men in five cities who underwent radical prostatectomy. The unadjusted rate of 30-day surgical complications varied across network subgroups from an 18.8 percentage-point difference in the rate of complications across network subgroups in city 1 to a 26.9 percentage-point difference in city 5. Large differences in unadjusted rates of late urinary complications and long-term incontinence across subgroups were similarly found. Network subgroup characteristics—average urologist centrality and patient racial composition—were significantly associated with rates of surgical complications.ConclusionsAnalysis of physician networks using Surveillance, Epidemiology and End Results-Medicare data provides insight into observed variation in rates of complications for localized prostate cancer. If validated, such approaches may be used to target future quality improvement interventions.     

Urinary Incontinence and Indwelling Urinary Catheters in Acutely Admitted Elderly Patients: Relationship With Mortality,Institutionalization, and Functional Decline

ObjectivesTo study differences in functional status at admission in acutely hospitalized elderly patients with urinary incontinence, a catheter, or without a catheter or incontinence (controls) and to determine whether incontinence or a catheter are independent risk factors for death, institutionalization, or functional decline.DesignProspective cohort study conducted between 2006 and 2008 with a 12-month follow-up.SettingEleven medical wards of 2 university teaching hospitals and 1 teaching hospital in the Netherlands.ParticipantsParticipants included 639 patients who were 65 years and older, acutely hospitalized for more than 48 hours.MeasurementsBaseline characteristics, functional status, presence of urinary incontinence or catheter, length of hospital stay, mortality, institutionalization, and functional decline during admission and 3 and 12 months after admission were collected. Regression analyses were done to study a possible relationship between incontinence, catheter use, and adverse outcomes at 3 and 12 months.ResultsOf all patients, 20.7% presented with incontinence, 23.3% presented with a catheter, and 56.0% were controls. Patients with a catheter scored worst on all baseline characteristics. A catheter was an independent risk factor for mortality at 3 months (odds ratio [OR] = 1.73, 95% confidence interval [CI] 1.10–2.70), for institutionalization at 12 months (OR = 4.03, 95% CI 1.67–9.75), and for functional decline at 3 (OR = 2.17, 95% CI 1.32–3.54) and 12 months (OR = 3.37, 95% CI 1.81–6.25). Incontinence was an independent risk factor for functional decline at 3 months (OR = 1.84, 95% CI 1.11–3.04).ConclusionThere is an association between presence of a catheter, urinary incontinence, and development of adverse outcomes in hospitalized older patients.     

The value of the marginalia as an adjunct to structured questionnaires: Experiences of men after prostate cancer surgery

In both research and clinical settings, men who survive prostate cancer emphasize the need for more open communication about the challenges they face. They explain that symptomatic dysfunction associated with treatment is grounded in complex social situations and relationships. Yet, structured quality of life questionnaires preclude expressions of the elaborate accounts they often evoke. We explore this in the case of prostate cancer. Seventy-one patients who had undergone radical prostatectomy at a mid-Atlantic University Medical Center, a Veterans Affairs medical center affiliated with the same university, or were US members of an international prostate cancer support group completed a survey protocol including assessments of urinary morbidity, psychosocial adjustment to illness (PAIS), and health status (SF-36). At the conclusion, a single open-ended item was offered; 48 offered an extended response. The open-ended item was recorded and analyzed qualitatively. Data were summarized according to four main themes: (1) quality of patient–physician communication; (2) change in sexual identity; (3) fear of cancer; and (4) the humiliation of urinary incontinence. Future research on outcomes of treatment and clinical inquiry must focus on methods that systematically capture patients experiences.     

Sexual function following treatment of localised prostate cancer with HDR-Ir-192 brachytherapy combined with external beam radiotherapy

BackgroundClinically localised prostate cancer can be treated with various modalities after which there are a comparable overall survival. In this study the sexual function and quality of life was evaluated in patients treated with brachytherapy combined with external beam radiotherapy (EBRT).Patients and methodsOne hundred and eleven patients with clinically localised prostate cancer were treated with HDR-Ir-192 brachytherapy in combination with EBRT from February 2000 to August 2003. An interview was conducted consisting of a questionnaire based on the International Index of Erectile Function (IIEF) and the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30, concerning erectile function and quality of life.ResultsOne hundred and three (96%) men consented for interview. The mean time following treatment was 28 months (range 6–36). Thirty-six men (35%) had normal erections at the time of interview, 23 men (22%) had no erections, 25 (25%), had variable erections whilst sexually active. Thirty men (29%) had had successful penetrative sexual intercourse in the 4 weeks preceding the interview each time they had attempted to do so. A further 15 (15%) had mostly successful penetration whenever they had tried during the previous 4 weeks. Nine (9%) had been unable to achieve penetration and 45 men (44%) had made no attempt at penetration. Importantly, 81 men (79%) indicated that their sexual function overall was reduced in comparison to the situation before treatment. Twenty-two men (21%) stated that their sexual function was unchanged and no man found that there had been an improvement as compared to pre-treatment.ConclusionA reasonable number of men (60%) had erections of variable quality at the time of interview following treatment. However, 79% of men stated that their overall level of sexual function was reduced post-treatment. We have insufficient comparative baseline data to enable us to make a direct comparison between pre- and post-treatment sexual function. Patients rated their general level of health and quality of life as good following treatment.     

Prevalence of erectile dysfunction and active depression: an analytic cross-sectional study of general medical patients

Erectile dysfunction is a common problem, affecting more than half of all men between the ages of 40 and 70 years. The authors' goal was to quantify the prevalence of concomitant erectile dysfunction and active depression among patients seen in a general medical setting between September 1998 and September 1999. Simple random sampling techniques were used to select a subset of 334 patients from 73 general medical practices affiliated with an academic tertiary referral center in Pennsylvania. Of the 334 patients sampled, the authors received responses from 268 subjects (80.2%) and completed questionnaires from 199 subjects (59.6%) with a mean age of 59 years. The survey instrument consisted of three major sections: demographic and health history information, the Center for Epidemiologic Studies Depression (CES-D) Scale, and the five-item version of the International Index of Erectile Function Scale. The prevalence of moderate or complete erectile dysfunction in this sample was 36.4% (95% confidence interval (CI): 29.6, 43.1). The prevalence of current depression by CES-D Scale criteria was 12.1% (95% CI: 7.5, 16.7), and the prevalence of concomitant erectile dysfunction and depression was 5.1% (95% CI: 2.0, 8.1). Using logistic regression, the authors found that current depressive symptoms were not associated with moderate or complete erectile dysfunction (odds ratio = 1.3, 95% CI: 0.5, 3.1; p = 0.565). Concomitant erectile dysfunction and depression represent a significant public health problem.     

What contributes more strongly to predicting QOL during 1-year recovery from treatment for clinically localized prostate cancer: 4-weeks-post-treatment depressive symptoms or type of treatment?

Purpose: Research on prostate cancer and quality of life (QOL) has focused on the effects of treatment type on subsequent QOL, without considering effects of depressive symptoms. The present purpose is to test the independent contribution of depressive symptoms (measured within 4 weeks after treatment) and treatment type in predicting QOL measured 4, 7, and 12 months following treatment for clinically localized prostate cancer. Methods: The 105 patients (all Stage I–II) were newly treated with radical prostatectomy, external beam radiation (EBR) or brachytherapy. Age ranged from 42 to 80 (mean = 64); 88% Caucasian and 9% African American. Repeated measures mixed linear models were adjusted for age, race, education, and marital status. Results: Depressive symptoms significantly (p < 0.01) predicted 8 of 10 disease-specific and␣7 of 7 generic QOL outcomes. Treatment type significantly (p < 0.01) predicted urinary function and bowel bother but no generic QOL outcomes. Conclusions: Depressive symptoms appears to predict a wider range of QOL outcomes (measured 4–12 months after treatment) than treatment type; however, when treatment is significant its effect sizes are slightly larger than depressive symptoms. Health care providers should (1) assess depressive symptoms in prostate cancer patients before and after treatment, and (2) provide psychosocial (e.g., counseling, support groups) and pharmacologic treatment options for improving depressive symptoms.     

Outcome Evaluation of a Multi-Disciplinary Community-Based Continence Service for Australian Women

ABSTRACT

This longitudinal study evaluated the effectiveness of a multi-disciplinary community-based service offering conservative treatment for Australian women suffering urinary incontinence and living independently in the community, in terms ofurinary incontinence symptom severity, impact on quality of life and knowledge outcomes. One hundred and twenty-three women attending The Waterworx Centre, a multi-disciplinary, publicly funded community-based continence service in South East Queensland Australia participated in the study. They received multi-disciplinary conservative treatment for urinary incontinence, including comprehensive assessment and an individually-tailored plan of care. All the women were also linked back to their own generalist health professional for ongoing care and management.

Data were collected over a one-year period: at first consultation, and at three months and six months following the first consultation. The International Continence Society Urinary Symptom Index Short Form-Female was used to measure urinary symptoms and impact on quality of life, and a researcher-developed test was used to measure changes in knowledge.

Results showed that the women experienced an improvement in urinary symptoms and continence-related knowledge at three months following first consultation, and a decreased impact on quality of life, with these improvements either being sustained or increasing at six months. This study demonstrated that multi-disciplinary community-based services offering specialist conservative treatment for women suffering urinary incontinence can be effective in achieving improvements in urinary symptoms and continence-related knowledge and reducing the impact of urinary incontinence on quality of life.     

Frequency of sexual problems and sexual dysfunction in middle-aged Danish men

The frequency of sexual dysfunction of a representative group of Danish middle-aged men was recorded, using a questionnaire and an interview that contained, respectively, 12 and 23 questions about sexual problems. The study sample consisted of 439 51-year-old men, all of whom received the questionnaire. Of these men, 100 were also interviewed. Interviewed men more frequently reported erectile dysfunction and previous contact with a therapist due to sexual problems at interview than in the questionnaire. Thus, 16 men (4% of the study population) who reported erectile dysfunction in the questionnaire constituted only a fraction of the true number. At interview nearly 40% of the men reported some kind of sexual dysfunction. There were, however, only 7% who found their problems abnormal for their age—and only 5% of the interviewed men intended to seek treatment for their problems.This project was supported by the Danish National Health Insurance Foundation (Journals H 11/118-86, H 11/80-87 and H 11/137-87) and utilized the statistical service of the Danish Medical Research Council.     

Response shift due to diagnosis and primary treatment of localized prostate cancer: a then-test and a vignette study

Aim Whether a prostate cancer diagnosis induces response shift has not been established so far. Therefore, we assessed response shift in men who were diagnosed with localized prostate cancer. Patients and methods Out of 3,892 men who completed a questionnaire before screening, 82 were subsequently diagnosed with prostate cancer. Response shift was assessed in 52 (response 63%) by the then-test (EuroQol self-rating of health, Short-Form 36 mental health and vitality) and a novel method: rating of vignettes relating to side effects of prostate cancer treatment (urinary, bowel and erectile dysfunction). Three then-tests were conducted: two referencing pre-diagnosis (measured pre- and post-treatment), and one referencing pre-treatment (measured post-treatment). Results Then-test scores of pre-diagnosis health were significantly higher than original scores, indicating a more positive judgement in retrospect. Then-test scores of pre-treatment health were lower than original scores. Especially the vignette on erectile dysfunction was rated less bad after diagnosis versus before (P < 0.001, moderate effect size). Conclusions We found evidence for response shift in men who were diagnosed with prostate cancer. Men evaluated urinary, bowel, and erectile dysfunction as less bad after they had become patients who can expect to experience these side effects. The rating of vignettes is a promising additional technique to assess response shift.     

Erectile function and risk of Parkinson's disease

Erectile dysfunction is common among individuals with Parkinson's disease, but it is unknown whether it precedes the onset of the classic features of Parkinson's disease. To address this question, the authors examined whether erectile dysfunction was associated with Parkinson's disease risk in the Health Professionals Follow-up Study. Analyses included 32,616 men free of Parkinson's disease at baseline in 1986 who in 2000 completed a retrospective questionnaire with questions on erectile dysfunction in different time periods. Relative risks were computed using Cox proportional hazards models adjusting for age, smoking, caffeine intake, history of diabetes, and other covariates. Among men who reported their erectile function before 1986, 200 were diagnosed with Parkinson's disease during 1986-2002. Men with erectile dysfunction before 1986 were 3.8 times more likely to develop Parkinson's disease during the follow-up than were those with very good erectile function (relative risk = 3.8, 95% confidence interval: 2.4, 6.0; p < 0.0001). Multivariate-adjusted relative risks of Parkinson's disease were 2.7, 3.7, and 4.0 (95% confidence interval: 1.4, 11.1; p = 0.008) for participants with first onset of erectile dysfunction (before 1986) at 60 or more, 50-59, and less than 50 years of age, respectively, relative to those without erectile dysfunction. In conclusion, in this retrospective analysis in a large cohort of men, the authors observed that erectile dysfunction was associated with a higher risk of developing Parkinson's disease.     

Adverse Event Reports Associated with Vaginal Mesh: An Interrupted Time Series Analysis

BackgroundSurgery with vaginal mesh is often used to treat female urinary incontinence. Questions have emerged over the past decade about the safety and efficacy of vaginal mesh devices.ObjectiveThis study examines trends in adverse event reports associated with vaginal mesh devices, testing the hypothesis that Food and Drug Administration (FDA) announcements will result in increased adverse event reports to the FDA.MethodsUsing interrupted time series regression models, we analyzed adverse event report data collected from the FDA's Manufacturer and User Facility Device Experience reporting system in 1998 through 2015.ResultsFDA announcements had limited effects on the number of adverse event reports, whereas an announcement from a mesh manufacturer that it was withdrawing devices from the market resulted in a large spike in reports.ConclusionsThese findings raise concerns about the dispersion of risk communications, the FDA's reliance on adverse event reports for postmarket surveillance, and the FDA's clearance of vaginal mesh without safety or efficacy testing.     

Seeking certainty through narrative closure: men's stories of prostate cancer treatments in a state of liminality

Radical treatments of prostate cancer often lead to a pervasive liminal state that is characterised by multiple uncertainties that relate both to a possible recurrence of cancer and recovery from side effects, such as erectile and urinary dysfunctions. Liminality can make it difficult for cancer patients to narrate their experiences, as their stories lack a definite ending. After interviews with 22 Finnish men who had undergone radical prostatectomy, we analysed how men produce closure in their illness narratives. Focusing on the timelines of control visits or their anticipated recovery from side effects, these interviewees sought provisional certainty within a seemingly chaotic future. By locating erectile dysfunction in the wider context of a life‐course and interpreting their fading sexuality as a ‘natural’ consequence of ageing, these men were adjusting to their post‐operative lives. Our study further shows that the inability to adjust personal experiences to positive culturally available storylines that provide a chance for the narrative reconstruction of life, can cause materialised negative consequences, such as relationship breakdowns.     

InVance球部悬吊术治疗前列腺癌根治术后压力性尿失禁

目的评价InVance球部悬吊术治疗前列腺癌根治术后压力性尿失禁的临床效果。方法回顾性分析2005年3月至2011年3月采用InVance球部悬吊术治疗6例前列腺癌根治术后压力性尿失禁患者的临床资料。结果6例手术时间80～120min,出血量20～50ml。术后2d拔除气囊导尿管,切口均Ⅰ期愈合。随访12～29个月,4例治愈,1例改善,1例无效。2例出现暂时性尿潴留,1例出现短期内会阴疼痛。6个月后最大尿流率（15．9±7．7）ml／s,残余尿量0-20ml／s。结论InVance球部悬吊术简单、创伤小、手术并发症少,对前列腺癌根治术后压力性尿失禁有较好疗效。     

Erectile dysfunction and radiation therapy for prostate cancer

The number of patients diagnosed with early stage prostate cancer (PC) has increased dramatically, because of routine prostate-specific antigen testing in the recent years and the possibility for cure of early disease. Radiation therapy is together with radical prostatectomy the most effective treatment for localized disease. Incidence of erectile dysfunction (ED) after radiotherapy (RT) reported in the literature vary from 6% to 84% after external-beam RT to 0–51% after brachytherapy. Most of these studies are retrospective, the definition of ED is variable and sexual functioning is frequently assessed by asking only one question. Already in the 1980s it was suggested that post-radiation ED was attributable to vascular damage. More recently, a strong relationship between radiation dose and volume of the penile bulb has been found. Though, a multifactorial etiology has to be considered taking into account pre-treatment erectile function. If radiation induces vascular damage that causes ED, any means of reducing the dose to the pelvic vascular structures would likely decrease ED. Patients need to be informed about the availability of effective treatments such as PDE5-I, intracavernosal injection and vacuum devices.     

Radiation therapy for primary vaginal carcinoma

Brachytherapy plays a significant role in the management of cervical cancer, but the clinical significance of brachytherapy in the management of vaginal cancer remains to be defined. Thus, a single institutional experience in the treatment of primary invasive vaginal carcinoma was reviewed to define the role of brachytherapy. We retrospectively reviewed the charts of 36 patients with primary vaginal carcinoma who received definitive radiotherapy between 1992 and 2010. The treatment modalities included high-dose-rate intracavitary brachytherapy alone (HDR-ICBT; two patients), external beam radiation therapy alone (EBRT; 14 patients), a combination of EBRT and HDR-ICBT (10 patients), or high-dose-rate interstitial brachytherapy (HDR-ISBT; 10 patients). The median follow-up was 35.2 months. The 2-year local control rate (LCR), disease-free survival (DFS), and overall survival (OS) were 68.8%, 55.3% and 73.9%, respectively. The 2-year LCR for Stage I, II, III and IV was 100%, 87.5%, 51.5% and 0%, respectively (P = 0.007). In subgroup analysis consisting only of T2–T3 disease, the use of HDR-ISBT showed marginal significance for favorable 5-year LCR (88.9% vs 46.9%, P = 0.064). One patient each developed Grade 2 proctitis, Grade 2 cystitis, and a vaginal ulcer. We conclude that brachytherapy can play a central role in radiation therapy for primary vaginal cancer. Combining EBRT and HDR-ISBT for T2–T3 disease resulted in good local control.