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Female sexual function evaluation and intraoperative vaginal reconstruction in bladder cancer

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Abstract

RC significantly negatively impacts sexual function (SF) in both men and women. While significant research resources have been allocated to examine the deleterious effects of post prostatectomy erectile dysfunction, little attention has been directed towards female sexual function and organ preservation post cystectomy. These academic shortcomings often result in poor provider awareness and inadequate preoperative assessment. As such, it is crucial for all providers involved in female RC care to understand the necessary and available tools for preoperative evaluation, in addition to the anatomic and reconstructive techniques. This review aims to summarize the current preoperative evaluation and available tools of SF assessment and describe in detail the varying operative techniques in the preservation or restoration of SF in women after RC. The review explores the intricacies of preoperative evaluation tools, and intraoperative techniques for organ- and nerve-sparing during radical cystectomy in females. Particular emphasis on vaginal reconstruction after partial or complete resection is provided, including split-thickness skin (STF) graft vaginoplasy, pedicled flaps, myocutaneous flaps and use of bowel segments. In conclusion, this narrative review highlights the importance of understanding anatomic considerations and nerve-sparing strategies in promoting postoperative SF and quality of life. Furthermore, the review describes the advantages and limitations of each organ- and nerve-sparing technique and their impact on sexual function and overall well-being.

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Abbreviations

BC:

Bladder cancer

RC:

Radical cystectomy

HRQoL:

Health-related quality-of-life questionnaires

BSO:

Bilateral Salpingo-oophorectomy

OC:

Ovarian cancer

PMDD:

Premenstrual dysphoric disorder

NCCN:

National comprehensive cancer network

SF:

Sexual function

SD:

Sexual dysfunction

QOL:

Quality of life

FACT–BI:

Functional assessment of cancer therapy–bladder

RRSO:

Risk reducing Salpingo-oophorectomy

TURBT:

Transurethral resection of bladder tumor

FACT–VCI:

Functional assessment of cancer therapy vanderbilt cystectomy index

BCI:

Bladder Cancer Index

EORTC:

European Organization for research and treatment of cancer

FSFI:

Female Sexual Function Index

CT:

Computer tomography

MRI:

Magnetic resonance imaging

mpMRI:

Multiparametric MRI

STS:

Split-thickness skin

SIS:

Small intestinal submucosa

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Acknowledgements

The authors would like to express their gratitude to Emma Helstrom for her assistance with manuscript revision and literary support.

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  1. Peace Orji and Helen Sun contributed equally as first author of the manuscript.

Authors and Affiliations

  1. Case Western Reserve School of Medicine, Cleveland, OH, USA

    Peace Orji, Helen Sun, Ilaha Isali, Nicholas Zaorsky, Kirtishri Mishra, Shubham Gupta & Adam Calaway

  2. Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Helen Sun, Ilaha Isali, Nicholas Zaorsky, Kirtishri Mishra, Shubham Gupta & Adam Calaway

  3. Department of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA

    Spencer Bell, Andres Correa, Marc Smaldone, Rosalia Viterbo & Laura Bukavina

  4. Department of Urologic Oncology, Fox Chase Cancer Center, Temple Health Medical Center, Philadelphia, PA, 19111, USA

    Laura Bukavina

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PO: project development, manuscript writing/editing. HS: manuscript writing/editing, data collection. II: manuscript writing/editing. SB: manuscript writing/editing. NZ: data collection, manuscript editing. KM: manuscript editing. SG: manuscript editing. AC: manuscript editing. MS: manuscript editing. AC: manuscript editing. RV: manuscript editing. LB: project development, manuscript writing/editing.

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Orji, P., Sun, H., Isali, I. et al. Female sexual function evaluation and intraoperative vaginal reconstruction in bladder cancer. World J Urol 41, 1751–1762 (2023). https://doi.org/10.1007/s00345-023-04502-z

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