Long-term sexual activity status and influencing factors in men after surgery for hypospadias

The aim of this study was to compare the long-term postoperative status of hypospadiac patients by analysing their sexual psychology, sexual behaviour, sexual function and influencing factors. A total of 130 hypospadiac patients hospitalized between January 1988 and December 2007 were followed up with questionnaires using Zung＇s Self-rating Depression Scale （SDS）, Self-rating Anxiety Scale （SAS）, a self-designed sexual function questionnaire and a 5-item version of the International Index of Erectile Function （IIEF-5）. The surveys served to evaluate the effects of hypospadias type, number of operations and surgical procedures on sexual psychology, sexual behaviour and sexual function. The control group consisted of 50 healthy adults. The postoperative SDS / SAS scores and occurrences of depression/anxiety in hypospadiac patients were significantly higher than those of normal controls （P 〈 0.001）. Patients with proximal hypospadias and multiple procedures differed from those with distal hypospadias and a single procedure in all parameters of sexual psychology （P 〈 0.05）. The average penile lengths and circumferences ofhypospadiac patients under either erect or flaccid conditions were significantly shorter than those of normal controls （P 〈 0.001）. A similar difference existed between patients with distal and proximal hypospadias （P 〈 0.01）. There was no significant difference in any parameter of sexual function between patients with different numbers of operations and surgical procedures. Hypospadiac patients were clearly impaired in sexual psychology and penile development. The severity of hypospadias and number of operations were key factors that influenced the sexual psychology of patients. This finding indicated the importance of long-term follow-up and psychological counselling for hypospadiac patients postoperatively.     

Urethrocutaneous fistula repair after hypospadias surgery

OBJECTIVE: To evaluate and compare the success rates of simple and layered repairs of urethrocutaneous fistulae after hypospadias repair. PATIENTS AND METHODS: The charts of 72 children who developed fistulae after hypospadias repair were reviewed; 39 had a simple closure of the fistula, whereas 32 had a 'pants over vest' repair, in all cases after excluding an impairment of urine outflow. RESULTS: The success rate at the first attempt was 74% for simple closure and 94% for the layered repair; at the second attempt it was 80% and 100%, the difference being statistically significant for both repairs. CONCLUSIONS: Although probably far from an optimal technique for repairing urethrocutaneous fistulae, the pants-over-vest repair allows a good success rate for penile shaft fistulae.     

Patient-reported long-term outcome after primary hypospadias repair

Purpose: Long-term evaluation of the surgical outcome after puberty, particularly patient reported outcome is rare in the literature. The aims of this study were to investigation the patients' satisfaction with the long-term results and their views and memories of their childhood surgery and follow-up.

Methods: A modified version of previously used questionnaire was sent to 134 patients ages 18 years or older previously primarily repaired due to hypospadias by one of the authors (HS) between 1989 -2009.

Results: Thirty-nine patients responded. Eighty-two per cent were satisfied with the appearance of their penis, 87% were satisfied with their ability to urinate and their sexual function and 92% were satisfied with the overall surgical results. Ninety per cent of patients were positive to the current duration of our post-pubertal follow-up program or would have preferred an even longer follow-up.

Conclusions: The majority of patients were satisfied with the long-term surgical results and the duration of follow-up. Despite having problems patients does not always contact the health care system spontaneously, which warrants long-term follow-up.     

Sexual function after aortic surgery

Background: Male patients attending for follow up after aortic surgery have often commented that there has been a change in their sexual function. Methods: A survey of patients attending vascular outpatient clinic and private practice following aortic surgery was carried out by personal interview. Results: Of those who were sexually active before operation, 40% thought that there had been a diminution in performance and 11% thought that there was some improvement. Similar results have been found in other centres. Conclusions: Aortic surgery carries a risk of diminution in sexual function as a consequence of the operation. It is the duty of the surgeon to warn patients of this risk when seeking informed consent.     

Variables in successful repair of urethrocutaneous fistula after hypospadias surgery

PURPOSE: We evaluate variables affecting the success of repairs of urethrocutaneous fistula after hypospadias surgery. MATERIALS AND METHODS: The records of 123 boys who underwent fistula repair at Primary Children's Medical Center were reviewed. Of these patients 100 underwent initial fistula repair at our center (surgery was performed at our center in 82 and elsewhere in 18) and 23 were referred from elsewhere after unsuccessful fistula repairs. Patient age was 6 months to 34 years (median 3.21 years) and interval between surgeries was 3.7 months to 12 years (median 12.6 months). Several variables potentially affecting the success of fistula closure were retrospectively assessed. RESULTS: Including those patients referred from outside hospitals, fistulas were successfully closed in 71%, 72%, 77%, 100% and 100% of these patients after fistula repairs 1 to 5, respectively. Variables studied yielded stent 67.7% (36 of 54 cases) versus no stent 76.1% (35 of 46) and operating microscope 70.4% (59 of 71) versus loupes 72.4% (21 of 29) in terms of success. Success based on patient age yielded 65.5% for younger than 2 years (n = 29 patients), 71.7% for 2 to 5 (46), 64.7% for 6 to 12 (17) and 87.5% for older than 12 (8). When considering the type of original hypospadias repair and its affect on fistula closure success, a significantly lower success was noted with Yoke and King procedures (p = 0.007 and 0.037, respectively). In patients who underwent hypospadias surgery and all subsequent fistula closure attempts at our center, fistulas were successfully repaired in 72%, 67% and 100% of patients after attempts 1 to 3, respectively. Initial fistula repair was successful in 72% (59 of 82) of patients who underwent original hypospadias surgery at our center and in 67% (12 of 18) of those referred after hypospadias surgery at an outside hospital. CONCLUSIONS: Regarding urethrocutaneous fistula closure, the data from this study suggest that there is no clear difference in stent versus no stent and microscope versus loupes, age at fistula closure does not affect success, type of original hypospadias procedure may influence success (King and Yoke procedures were least successful), success rate is not negatively impacted in recurrent fistula cases, given a diverse group of fistulas, success of fistula repair for attempts 1 to 5 was 71%, 72%, 77%, 100% and 100%, respectively, and success rate in a tertiary pediatric urology setting is not influenced by whether the original hypospadias procedure or initial fistula closure was performed in the pediatric urology setting versus outside hospital.     

Psychosexual adjustment and age factors in 130 men undergone hypospadias surgery in a Chinese hospital

The study investigated the psychosexual status and sexual function in adults who had hypospadias surgery at different ages. A detailed questionnaire was mailed to 130 patients who underwent hypospadias surgery between January 1988 and December 2007, and 50 healthy males who served as the control group. The patients were divided into three groups based on their age at which surgery was completed: group A (n=32; <10 years); group B (n=45; 10-18 years); and group C (n=53; >18 years). The Zung Self-Rating Anxiety Scale and The Zung Self-Rating Depression Scale were used to assess psychosexual status; a designed questionnaire and the International Index of Erectile Function-5 were used to assess sexual function. The incidence of anxiety and depression was significantly higher in patients than that in controls (P < 0.001), and was correlated with the age at which surgery was completed. The length and circumference of penises in patients were shorter than those of control groups with statistically significant differences (P < 0.01). There were no significant differences between patients and controls regarding libido strength, overall sexual satisfaction and erectile function (P > 0.05). In conclusion, difference existed in certain aspects of psychosexual and penile development between patients and controls. Hypospadias surgery should be performed early.     

Hypospadias repair in adults: adventures and misadventures

PURPOSE: To evaluate long-term results and complications we reviewed the records of 42 consecutive men 18 to 47 years old (mean age 22.5) who underwent hypospadias repair between 1979 and 1999. MATERIALS AND METHODS: The study population was divided into groups 1 consisting of 8 patients without previous hypospadias surgery, 2 consisting of 12 who underwent 1 or more procedures in childhood but in whom local tissue was relatively intact and 3 consisting of 22 who underwent multiple unsuccessful hypospadias repairs with various degrees of penile deformity and loss of local tissue. RESULTS: Complications were noted in 3 of 8 (37.5%), 5 of 12 (41.67%) and 14 of 22 (63.6%) patients in groups 1 to 3, including 3 (100%), 4 (80%) and 10 (71.4%), respectively, in whom secondary surgery was successful in the long term. A patient in group 2 and 2 in group 3 await further surgery, while 2 in group 3 were lost to followup. Overall primary complications developed in 22 of the 42 men (52.3%) and 5 of the 22 (22.7%) had secondary complications. There was long-term success in 37 of 42 cases (88.1%). CONCLUSIONS: The results of hypospadias repair in adulthood differ from the results of similar procedures in childhood. Although the various techniques are similar, there is clearly a difference in terms of wound healing, infection, complication rates and overall success. Adults undergoing hypospadias repair must be counseled on all of these variables to avoid unreasonable expectations.     

多孔硅胶支架管在尿道下裂术后尿道狭窄修复术中的应用

目的:探讨多孔硅胶支架管在尿道下裂术后尿道狭窄修复中的效果。方法:2008～2012年在26例尿道下裂术后尿道狭窄修复术中使用多孔硅胶支架管做新建尿道的支架,观察术后尿道感染、再狭窄情况。结果:术后随访半年到1年,26例病人无一例发生术区感染,1例出现不同部位的狭窄,2例(采用口腔黏膜)出现明显瘢痕增生导致再次狭窄。结论:采用多孔硅胶支架管做新建尿道的支架可以减少术后尿道感染机会,有效减轻再造尿道的挛缩,防止再次形成尿道狭窄,提高手术成功率,降低手术并发症,值得进一步推广。     

Preservation of sexual and bladder function after laparoscopic rectal surgery

Background  There have recently been reports of higher levels of bladder and sexual dysfunction in men after laparoscopic rectal surgery when compared with those undergoing open surgery. This has led some surgeons to question the role of the laparoscopic approach to rectal surgery.
Method  This study represents a retrospective analysis of a prospectively collected database for a single unit, comprising 2406 patients undergoing laparoscopic colorectal surgery. Bladder function, potency and ejaculation were assessed at postoperative clinic visits for men undergoing laparoscopic low or ultra-low anterior resection and abdominoperineal excision of the rectum.
Results  A total of 101 males were identified (median age 62 years: range 20–90 years). Urinary dysfunction was reported by six (6%) patients. Six (6%) patients had sexual dysfunction, manifesting as retrograde ejaculation in four patients and erectile dysfunction in a further two patients.
Conclusions  The low rates of sexual dysfunction in this unit may be attributable to pelvic dissection only being undertaken by experienced, dedicated laparoscopic colorectal surgeons. Laparoscopic restorative surgery for rectal cancer has been performed here only since 2001 after considerable experience accrued in operating on benign rectal disease and colon cancer. Studies from elsewhere reporting poorer functional outcomes have probably included a significant number of patients on the surgeons'learning curve'.     

Sexual function after robot-assisted prolapse surgery: a prospective study

Introduction and hypothesis

Female pelvic organ prolapse (POP) can severely influence sexual function. Robot-assisted surgery is increasingly used to treat POP, but studies describing its effect on sexual function are limited. The objective of this study was to evaluate sexual function after robot-assisted POP surgery.

Methods

This prospective cohort study included all patients who underwent a robot-assisted sacrocolpopexy (RASC) or supracervical hysterectomy with sacrocervicopexy (RSHS). Exclusion criteria were unknown preoperative sexual activity status or concomitant surgery. In sexually active women, sexual function was measured with the translated validated version of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Changes in sexual activity were scored. Prolapse stages were described using the simplified Pelvic Organ Prolapse Quantification (S-POP) system.

Results

A total of 107 women were included (median follow-up 15.3 months). No difference was found in the total number of sexually active women before and after surgery [63 (58.9%) vs. 61 (63.5%), p?=?0.999]. Significantly fewer women avoided sexual intercourse postoperatively compared with preoperatively. Preoperatively, sexual intercourse was avoided due to vaginal bulging (2% vs. 24%, respectively, p?=?0.021). Total mean PISQ-12 scores improved significantly 1 year after prolapse correction (33.5 vs. 37.1; p?=?0.004), mainly due to improved scores on the physical and behavioral–emotive domain. No significant difference in pre- and postoperative complains of dyspareunia was found.

Conclusion

Robot-assisted middle-compartment surgery improved sexual function 1 year after surgery according to enhanced physical and emotional scores. The total number of sexually active women and complains of dyspareunia before and after surgery did not differ.

     

性行为指导的个体化治疗对血精症治疗的作用探讨（附89例报告）

目的探讨性行为指导的个体化治疗在非肿瘤性血精症治疗中的作用。方法自2005年2月—2008年4月,89名非肿瘤性血精症患者随机分为常规治疗组(32例)和个体化治疗组(57例)。常规治疗组予以抗生素、安络血、维生素C口服。个体化治疗组根据精液、前列腺液常规分析及前列腺液或精液细菌培养,分为感染性和非感染性血精症,通过对患者的性行为指导,予以性行为指导的个体化治疗,并随访观察治疗效果。结果个体化治疗组治愈率和复发率为95.7%和3.5%,常规治疗组的治愈率和复发率为60.9%和9.4%。经x2检验,治疗结果有显著性差异,个体化治疗组优于常规治疗组(P<0.05)。结论性行为指导的个体化治疗非肿瘤性血精症疗效显著,具有较好的临床价值。     

广州地区不同年龄成年女性性行为方式调查

目的 了解广州地区不同年龄成年女性的性行为方式,为开展性健康教育提供依据.方法 用统一编制的调查表,以匿名问卷形式横断面调查380名成年女性,共回收问卷324份,回收率81.0%.324名女性年龄分布在20～50岁之间,分为A、B、C 3组,其中A组20岁～133人(41.0%),B组30岁～131人(40.4%),C组40岁～60人(1 8.5%).结果 手淫:A、B、C 3组手淫的人数比较(3组间两两比较),差异无统计学意义(P>0.05).性爱抚:A组与B组,B组与C组比较,差异无统计学意义(P>0.05),A组与C组比较,差异有统计学意义(P<0.05).口交:A组与B组比较,差异无统计学意义(P>0.05),A组与C组,B组与C组比较,差异均有统计学意义(P<0.05).变换体位:A、B、C三组性交时变化体位的频率比较,差异无统计学意义(P>0.05).性交频率:B组与C组比较,差异无统计学意义(P<0.05),A组与B组,A组与C组比较,差异有统计学意义(P<0.001).结论 广州地区成年女性受到传统性观念的影响,以性交为主要的性生活方式.但是随着年龄的增加,性交的次数减少,而以性爱抚以及变换性交体位等方式来提高性生活的乐趣和获得性满足.虽然成年女性对于手淫和口交等受到传统观念排斥的性行为方式仍保持负面的态度,年轻的女性受到开放性观念的影响,对口交的接受程度有所增加.     

Female sexual dysfunction after pelvic surgery: the impact of surgical modifications

The truly international authorship every month in the Journal is reflected in the Mini‐Review section in this issue. One from the USA, one from Canada, and two from Italy. It is a great pleasure to the Editor that this is so, and I hope also to the readership and to those who make such excellent contributions. The topics covered are female sexual dysfunction after pelvic surgery, zoledronic acid in prostate and renal cancers, intravesical gemcitabine for superficial bladder cancer, and the reduction of patient discomfort during TRUS‐guided biopsy of the prostate.     

Surgical treatment options in proximal hypospadias: retrospective analysis of 171 cases at a single institution

Aim So far, various techniques have been used in the surgical treatment of proximal hypospadias. The aim of all techniques is to form a near to normal penis functionally and cosmetically. In the present study, proximal hypospadias cases operated in our clinic were evaluated. Material method Overall 171 cases with proximal penile, penoscrotal and scrotal meatus, aged between 3 and 28 were included in the study. Early and late postoperative complication rates and factors affecting success were investigated retrospectively. Results Sixteen cases underwent Duckett, 20 Onlay, 28 free tube, 56 Belt-Fuqua and 51 Thiersch operations. Success rate at early postoperative period was 60.8%, while it became 81.2% following secondary interventions. Conclusion No effect of operation technique and meatus levels were observed on complication rates whilst previous operation increased complication rates significantly.