Maria Teresa Filocamo

Sexual dysfunction in women during dialysis and after renal transplantation.

INTRODUCTION Disorders of the reproductive system and menstrual abnormalities often associated with loss of libido and inability to reach orgasm are common in adults of both sexes with an end-stage renal disease. These symptoms may significantly contribute to depression and reduce the sexual activity of women. AIM To determine if sexual function, as well as hormonal status, improves after kidney transplantation, comparing a group of pre-menopausal women during dialysis and after a successful renal transplantation. METHODS We enrolled 58 women that received kidney transplantation. Patients included were 18-45 years old, on hemodialysis for more than 6 months following a fully functioning kidney transplantation, and on a stable corticosteroids immunosuppressive regimen for at least 6 months. All women underwent a general and urogynecological examination, a hormonal profile determination, and filled out the Female Sexual Function Index (FSFI) and a Beck Depression Inventory questionnaire administered during dialysis and 12 months after transplantation. MAIN OUTCOME MEASURES We evaluated the prevalence of Female Sexual Dysfunction according to the FSFI cutoff points, sexual hormonal status, and menstrual status during dialysis and 12 months after kidney transplantation. RESULTS Nineteen out of 58 women left the study prematurely. Thirty-nine women (mean age 36 +/- 5.9 years) completed the study. A total of 74% of the patients had menstrual disturbances during dialysis, as opposed to 45% after transplantation (P < 0.001). Sixteen out of 39 (41%) patients acknowledged having an active sexual life during dialysis. Thirty-four out of 39 (88%) transplanted patients acknowledged having an active sexual life (Fischers exact test P = 0.000039). The hormonal profile and FSFI results improved significantly after transplantation. CONCLUSION This study demonstrates that a successful transplantation should improve the sexual life in women with chronic renal failure.

The Female Sexual Function Index (FSFI): Linguistic Validation of the Italian Version

INTRODUCTION Although several new measurements for female sexual dysfunction (FSD) have recently been developed, the Female Sexual Function Index (FSFI) remains the gold standard for screening and one of the most widely used questionnaires. The Italian translation of the FSFI has been used in several studies conducted in Italy, but a linguistic validation of the Italian version does not exist. AIM The aim of this study was to perform a linguistic validation of the Italian version of the FSFI. METHODS A multicenter cross-sectional study conducted in 14 urological and gynecological clinics, uniformly distributed over Italian territory. We performed all steps necessary to determine the reliability and the test-retest reliability of the Italian version of the FSFI. The study population was a convenience sample of 409 Italian women. MAIN OUTCOME MEASURES The reliability of the questionnaire was calculated using Cronbachs alpha, which was considered weak, moderate, or high if its value was found less than 0.6, between 0.6 and 0.8, or equal to or greater than 0.8, respectively. The test-retest reliability was assessed for all women in the sample by calculating Pearsons concordance correlation coefficient for each domain and for the total score, both at baseline and after 15 days (r range between -1.00 to +1.00, where +1.00 indicates the strongest positive association). RESULTS Cronbachs alpha coefficients for total and domain score were sufficiently high, ranging from 0.92 to 0.97 for the total sample. The test-retest procedure revealed that the concordance correlation coefficient was very high both for FSFI-I total score (Pearsons P = 0.93) and for each domain (Pearsons P always >0.92). CONCLUSION For the first time in the literature, our study has produced a validated and reliable Italian version of the FSFI questionnaire. Consequently, the Italian FSFI can be used as a reliable tool for preliminary screening for female sexual dysfunction for Italian women.

The Impact of Mid-Urethral Slings for the Treatment of Urodynamic Stress Incontinence on Female Sexual Function: A Multicenter Prospective Study

INTRODUCTION Urinary incontinence is a common condition that negatively impacts on female sexuality (FS). AIM To evaluate FS before and after a mid-urethral sling (MUS) procedure using the Female Sexual Function Index (FSFI). We included women that were both sexually and nonsexually active at baseline. METHODS One hundred fifty-seven women complaining of urodynamic stress incontinence underwent a MUS procedure and were enrolled in the study. All patients answered the Italian translation of FSFI, before and 12 months after surgery. To understand the real impact of the MUS on female sexual function, for the first time in the literature, we also monitored and included in the final analysis all the women who are nonsexually active at baseline. We evaluated the prevalence of female sexual dysfunction according to the FSFI cutoff point (26.55). MAIN OUTCOME MEASURES FSFI total score, pads use, and stress test presurgery and postsurgery. RESULTS One hundred thirty-three patients completed the study protocol: 105 out of 133 underwent to a trans-obturator procedure, while 28 out of 133 had a retropubic procedure. After the 12-month follow up, 115 out of 133 patients (86%) were dry, 10 improved their symptoms, and the remaining 8 were unchanged. Seventy-nine out of 133 (59%) patients reported an active sexual life before surgery. Fifty-four (41%) reported they were not sexually active before surgery. Twelve months after surgery, 22 out of 54 nonsexually active women (40%) reestablished sexual activity, whereas only 6 out of 79 (7.5%) patients, sexually active at baseline, were not sexually active 1 year after surgery (P < 0.05). After adjusting for multiple testing, only age, menopause, and storage symptoms remained significantly correlated with the FSFI total score postsurgery as independent variables. Conclusions.  Our data showed that after a MUS procedure, female sexual function improves. We also found that a very relevant percentage of nonsexually active women reported renewed sexual activity after MUS.

Use of sigmoid colon in orthotopic neobladder reconstruction: Long-term results

To present our experience with a sigmoid orthotopic neobladder.

Radical retropubic prostatectomy for prostate cancer with microscopic bladder neck involvement: survival and prognostic implications

Study Type – Therapy (case series)
Level of Evidence 4

Response to Editorial Comment to Use of sigmoid colon in orthotopic neobladder reconstruction: Long-term results

We thank Dr Abe for the opportunity to focus on some aspects of our article. Our index of early complications depends above all on a studied selection of candidates. As we had stated, just 19.1% of cystectomy patients receive a sigmoid neobladder. Any candidate not in optimal health with severe comorbidities was excluded, as noted in the text. Regarding postoperative management, all patients are admitted to a recovery room until they are fully awake, then they are admitted to subintensive care (or intensive care when required) until normal bowel function resumes. They receive parenteral hypercaloric nutrition during the first few postoperative days. Another protective factor could be surgical constancy – all patients were operated on by the same two experienced surgeons. Regarding pouch perforation, we have encountered this problem only once and it did not represent a life-threatening scenario. The patient was managed conservatively, with neobladder catheterization for 5 weeks. In fact, the thick sigmoidal wall probably prevents perforation. We agree that follow up of these patients never ends, it continues until death because in the long term, changes in their body can alter organ functionality and metabolism. In reality, we never interrupt contact with our patients. Regarding continence, we underline that no consensus on the definition of continence in patients who have undergone neobladder reconstruction has been formulated, and this fact impacts standards in reported data. Our continence standards are stringent: the definition of continence signifies no pads or condom devices during the day and at night. Furthermore, patients who carry out clean intermittent catheterization are separated from the continent group into a category of their own. We recognize them as having a distinct functional outcome. Therefore, had we counted as continent patients who carry out clean intermittent catheterization or use up to two pads/ day (as do some authors) our continence rates would have been higher.

Urological dysfunctions in young women.” Is it an inheritance of childhood? "

Hypothesis / aims of study Patients with overactive bladder syndrome refractory to behavioural interventions and pharmacotherapy remain a difficult-to-treat population. Second-line treatment options include either intravesical injection of botulinum toxin A or sacral neuromodulation (SNM). Whilst neuromodulation requires surgical intervention for both test evaluations and permanent implantation, the use of intravesical botulinum toxin requires repeated treatments, with the potential for development of urinary tract infections, incomplete emptying and need for intermittent self-catheterisation.