Introduction

Patient reports of health related quality of life (HRQoL) are being used to facilitate understanding of the physical and psychological impacts of surgery in patients with bladder cancer. Presently, the true effect of radical cystectomy (RC) on female sexual function is poorly described. The aim of this study is to prospectively report baseline and post-operative sexual function in a group of females undergoing RC.

Methods

Seventy-four females undergoing RC for bladder cancer were enrolled from 2008-2014 in a prospective HRQoL study. The Female Sexual Function Index (FSFI) was administered 1 month prior to RC, 6- and 12-months post-operatively. Latent Transition Analysis (LTA) was conducted at all 3 points in time to assign patients to homogeneous groups based on their survey responses (i.e., patients with similar responses were grouped together). Group membership was modeled by marital status, type of urinary diversion, vaginal reconstruction, and administration of neoadjuvant chemotherapy. LTA was also used to estimate transitions between groups over time.

Results

Sixty patients completed baseline surveys and 47 (64%) one year following cystectomy. Median age of the cohort was 66 (IQR 59,72) and 62 patients (84%) underwent vaginal reconstruction with RC. LTA revealed that at baseline, 65% of patients provided responses that were characterized as having &[prime]no sexual activity&[prime] (group 1), 17% &[prime]limited sexual function&[prime] (group 2), and 18% &[prime]adequate sexual function&[prime] (group 3). The distributions were stable one year after RC (65%, 21%, and 14% for the 3 groups, respectively). Analyzing transitions between preop grouping and at 1 year revealed that 44% of patients with adequate sexual function (group 3) remained unchanged. In group 2, 33% remained in the same category, while 21% transitioned to group 3. For patients reporting no sexual activity pre-op, 87% remained in the same category at 1 year, but 8% and 5% transitioned to groups 2 & 3 respectively. Being married was significantly associated with sexual function after surgery (p<0.001). No significant association was found based on the type of urinary diversion, vaginal reconstruction, or neoadjuvant chemotherapy.

Conclusions

Although a large proportion of females are not sexually active either before or after RC, one third of patients in this study maintained sexual function, with a small proportion demonstrating improvement at 1 year. Enhanced understanding of pre-op and post-op sexual function can lead to improved peri-operative counseling & surgical planning for sexually active females undergoing RC.

Funding

none