Sexual dysfunction with the incidence of 5%-90% is a common postoperative complication of rectal cancer and the ratio of men and women is similar. Sexual function is innervated by the abdominal-pelvic autonomic nerve. Different sexual dysfunctions can be caused by different parts and degrees of injury in autonomic nerve during operations of rectal cancer. With the development of pelvic autonomic nerves preservation in rectal cancer radical resection, postoperative sexual function can be protected. There may be many factors increasing the incidence of postoperative sexual dysfunction in rectal cancer, such as postoperative psychological factors, stoma, abdominal-perineal resection and radiotherapy. The effects of laparoscopic surgery, robotic surgery, transanal total mesorectal excision and lateral lymph node dissection on postoperative sexual function remain controversial. Based on the multidisciplinary cooperation model, attention should be paid to psychological intervention of patients and their partners. In clinical practice, for male using phosphodiesterase-5 inhibitors, vacuum erectile devices, injection of vasodilators through the penis or urethra, and for female local application of estrogen and lubricants in the vagina are effective treatment for postoperative sexual dysfunction of rectal cancer. In addition, stem cell therapy has a promising prospect for sexual dysfunction.
Female ; Humans ; Laparoscopy ; Lymph Node Excision ; Male ; Rectal Neoplasms/surgery* ; Rectum/surgery* ; Sexual Dysfunction, Physiological/etiology*

Female ; Humans ; Consensus ; East Asian People ; Urogenital Abnormalities/surgery* ; Sexual Dysfunction, Physiological/surgery*

OBJECTIVETo investigate the correlation between redundant prepuce and premature ejaculation.

METHODSFifty-two cases suffering from premature ejaculation and redundant prepuce were treated with circumcision. They were asked to fill the investigating questionnaire about the changes of ejaculatory latent period, patients' and their wives' satisfaction with sexual life before and after the treatment.

RESULTSDuring 12 months after circumcision, 28 cases were cured and 11 cases were efficacious. The curative rate was 54.9% and effective rate was 76.5%. Twelve cases with no responding continued to be treated with routine methods, such as psychotherapy, daub narcotic to glans of penis and taking medicine to treat chronic prostatitis, which were used before circumcision but still no effects. During 18 months after circumcision, 4 cases were cured and 5 cases were efficacious.

CONCLUSIONRedundant prepuce had direct or indirect relationship with premature ejaculation. The circumcision is one of the effective methods to treat premature ejaculation.

Adult ; Aged ; Circumcision, Male ; Ejaculation ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Sexual Dysfunction, Physiological ; surgery

Male patients with prolactinomas usually present with typical hyperprolactinemia symptoms, including sexual dysfunction and infertility. However, clinical factors related to sexual dysfunction and surgical outcomes in these patients remain unclear. This study aimed to investigate the outcomes of male patients with prolactinomas after transsphenoidal surgery and the risk factors affecting sexual dysfunction. This study was conducted on 58 male patients who underwent transsphenoidal surgery for prolactinomas between May 2014 and December 2020 at the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. We evaluated the sexual function of patients before and after surgery through International Index of Erectile Function-5 scores, libido, and frequency of morning erection. Of the 58 patients, 48 (82.8%) patients had sexual intercourse preoperatively. Among those 48 patients, 41 (85.4%) patients presented with erectile dysfunction. The preoperative International Index of Erectile Function-5 scores in patients with macroprolactinomas were significantly higher than those in patients with giant prolactinomas (17.63 ± 0.91 vs 13.28 ± 1.43; P = 0.01). Postoperatively, the incidence of erectile dysfunction was 47.9%, which was significantly lower than that preoperatively (85.4%; P = 0.01). Twenty-eight (68.3%) patients demonstrated an improvement in erectile dysfunction. Tumor size and invasiveness were significantly correlated with the improvement of erectile dysfunction. Preoperative testosterone <2.3 ng ml^-1 was an independent predictor of improvement in erectile dysfunction. In conclusion, our results indicated that tumor size and invasiveness were important factors affecting the improvement of sexual dysfunction in male patients with prolactinoma. The preoperative testosterone level was an independent predictor related to the improvement of erectile dysfunction.
Humans ; Male ; Prolactinoma/surgery* ; Erectile Dysfunction/etiology* ; Retrospective Studies ; Sexual Dysfunction, Physiological/complications* ; Testosterone ; Pituitary Neoplasms/pathology*

OBJECTIVETo investigate the correlation of premature ejaculation (PE) with central lumber intervertebral disc herniation (CLIDH) and the pathogenesis of PE, and to search for a convenient, effective and non-invasive method for the treatment of PE.

METHODSA total of 263 selected PE patients underwent CT, and those that were found with CLIDH were randomized into a treatment group (n=180) and a control (n=60), the former treated by lumbar traction and the latter with sertraline hydrochloride tablets, both for 24 weeks. CIPE-5 scores of all the patients were analyzed, and the ejaculation latency and sexual satisfaction were recorded before and after the treatment.

RESULTSAmong the 263 PE patients, CLIDH was confirmed in 240 (91%). After the treatment, CIPE-5 scores, ejaculation latency and sexual satisfaction were markedly improved in the treatment group, with significant statistic difference from pre-treatment (P < 0.01). Significant differences were also observed between the treatment and the control groups after the treatment (P < 0.05), but not in the control group between pre- and post-treatment.

CONCLUSIONCLIDH may be one of the important causes of most "unexplainable" PE cases. And lumbar traction, non-invasive, highly effective and easily manipulable, has provided a new access to the diagnosis and treatment of the PE patients with CLIDH.

Adult ; Ejaculation ; Humans ; Intervertebral Disc Displacement ; complications ; surgery ; Lumbar Vertebrae ; Male ; Middle Aged ; Sexual Dysfunction, Physiological ; etiology ; therapy ; Traction

OBJECTIVETo investigate the number, course and distribution of normal dorsal penile nerves and their clinical significance for selective neurectomy of the dorsal penile nerve in the treatment of primary premature ejaculation.

METHODSWe dissected 38 cadaveric adult penises and recorded the number, course and distribution of the dorsal penile nerves. A total of 314 cases of primary premature ejaculation underwent selective neurectomy of the dorsal penile nerve. The patients ranged between 20 and 45 years in age and from 1 to 22 years in disease course.

RESULTSThe dorsal penile nerves were distributed in parallel bilaterally in all the cadaveric penises and branched into the ventral side in 4 of them. The total number of dorsal penile nerves was (3.6 +/- 1.2) in the 38 cadaveric penises, 7 in 1 case, 6 in 1 case, 5 in 6 cases, 4 in 9 cases, 3 in 14 cases and 2 in 7 cases, while that of the 314 patients with primary premature ejaculation was (7.0 +/- 1.9), 5 in 64 cases, 6 in 56 cases, 7 in 52 cases, 8 in 40 cases, 9 in 33 cases, 10 in 28 cases, 11 in 25 cases, 12 in 11 cases and 13 in 5 cases. Selective neurectomy of the dorsal penile nerve achieved an intravaginal ejaculation latency of (4.31 +/- 1.87) minutes and sexual satisfaction rate of (61 +/- 17) %, significantly different from those before the operation ([1.24 +/- 0.32] min, [23 +/- 6] %; all P < 0.01).

CONCLUSIONThe abnormal increase of dorsal penile nerves possibly lies at the bottom of the pathogenesis of primary premature ejaculation. Selective neurectomy of the dorsal penile nerve is safe and effective for the treatment of primary premature ejaculation.

Adult ; Denervation ; methods ; Ejaculation ; Humans ; Male ; Middle Aged ; Neuroanatomy ; Penis ; innervation ; Peripheral Nerves ; anatomy & histology ; surgery ; Sexual Dysfunction, Physiological ; physiopathology ; surgery ; Treatment Outcome ; Young Adult

OBJECTIVETo evaluate the safety and effect of selective resection of the branches of the two dorsal penile nerves in the treatment of primary premature ejaculation (PPE).

METHODSFrom September 2003 to December 2006, 483 PPE patients aged 21-71 years (mean 32) underwent selective resection of the branches of the two dorsal penile nerves, with only 2 of the branches reserved, 3 resected in 89 cases, 4 in 183, 5 in 125, 6 in 38, 7 in 32, 8 in 12, 9 in 3 and 10 in 1. The patients could have sexual intercourse 4 weeks after the operation and were followed up for 3-36 months.

RESULTSNo infection, hemorrhage and erectile dysfunction were observed. Decreased penile sensibility was noted in all the patients, obviously prolonged ejaculation latency in 352, improvement in 93 and failure in 38, with a total effectiveness rate of 92.13%.

CONCLUSIONSelective resection of the branches of the two dorsal penile nerves, which can definitely reduce the sensivity of the penis, is a safe and effective surgical option for the treatment of PPE.

Adult ; Aged ; Denervation ; methods ; Ejaculation ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Penis ; innervation ; Sexual Dysfunction, Physiological ; physiopathology ; surgery ; Treatment Outcome ; Young Adult

OBJECTIVETo evaluate the impact on sexual function, local recurrence and survival after total mesorectal excision (TME) with autonomic nerve preservation (PANP) of rectal cancer.

METHODSOne hundred and five patients after TME with PANP were followed by means of questionnaire on postoperative genital function [TME + PANP(+) group], and the results of 110 patients after TME without PANP [TME + PANP(-) group] were compared with, also their local recurrence and 5-year survival were retrospectively analyzed.

RESULTSTME + PANP(+) group was compared to TME + PANP(-) group: the erection dysfunction, 33.3% vs 63.2%; the ejaculation dysfunction, 43.8% vs 70.0% (P < 0.01), there were significant differences between two groups, but no difference in local recurrent rate and 5-year survival rate (7.6% vs 5.5%; 63.4% vs 59.7%, P > 0.05).

CONCLUSIONThe TME with PANP of rectal surgery ensure the radical cure of rectal cancer, at the same time reasonably save the postoperative sexual function and obtain satisfactory postoperative survival.

Adult ; Aged ; Autonomic Nervous System ; injuries ; Follow-Up Studies ; Humans ; Male ; Mesentery ; surgery ; Middle Aged ; Neoplasm Recurrence, Local ; prevention & control ; Postoperative Complications ; prevention & control ; Rectal Neoplasms ; mortality ; surgery ; Retrospective Studies ; Sexual Dysfunction, Physiological ; etiology ; prevention & control ; Survival Rate ; Treatment Outcome

OBJECTIVETo evaluate male sexual function in a series of rectal cancer patients randomized to laparoscopic(LS) or open surgery(OS).

METHODSBetween June 2006 and October 2007, a total of 119 patients with rectal cancer were randomly assigned to laparoscopic(n=60) or open (n=59) resection group. All the patients were treated by D(3) lymphadenectomy combined with pelvic autonomic nerve preservation(PANP) technique. Sexual function was assessed by International Index of Erectile Function(IIEF) before surgery and on 3, 6 and 12 months after operation.

RESULTSSexual dysfunction rate of LS and OS at 3rd month after operation were 23.3% and 32.3% respectively, and 18.3% vs 27.1% after 6 months, and 11.6% vs 16.9% after 12 months. There were no significant difference between LS and OS in sexual dysfunction rate after surgery.

CONCLUSIONSLaparoscopic D(3) lymphadenectomy combined with PANP is not associated with higher sexual dysfunction rate, and the sexual function after laparoscopic surgery is satisfactory.

Adult ; Aged ; Autonomic Pathways ; surgery ; Follow-Up Studies ; Humans ; Laparoscopy ; methods ; Lymph Node Excision ; Male ; Middle Aged ; Neoplasm Staging ; Pelvis ; innervation ; Rectal Neoplasms ; physiopathology ; surgery ; Sexual Dysfunction, Physiological ; etiology

The clinical effect of laparoscopic rectal cancer curative excision with pelvic autonomic nerve preservation (PANP) was investigated. This study evaluated the frequency of urinary and sexual dysfunction of 149 male patients with middle and low rectal cancer who underwent laparoscopic or open total mesorectal excision with pelvic autonomic nerve preservation (PANP) from March 2011 to March 2013. Eighty-four patients were subjected to laparoscopic surgery, and 65 to open surgery respectively. The patients were followed up for 12 months, interviewed, and administered a standardized questionnaire about postoperative functional outcomes and quality of life. In the laparoscopic group, 13 patients (18.37%) presented transitory postoperative urinary dysfunction, and were medically treated. So did 12 patients (21.82%) in open group. Sexual desire was maintained by 52.86%, un-ability to engage in intercourse by 47.15%, and un-ability to achieve orgasm and ejaculation by 34.29% of the patients in the laparoscopic group. Sexual desire was maintained by 56.36%, un-ability to engage in intercourse by 43.63%, and un-ability to achieve orgasm and ejaculation by 33.73% of the patients in the open group. No significant differences in urinary and sexual dysfunction between the laparoscopic and open rectal resection groups were observed (P>0.05). It was concluded that laparoscopic rectal cancer radical excision with PANP did not aggravate or improve sexual and urinary dysfunction.
Adult ; Autonomic Nervous System ; injuries ; Humans ; Laparoscopy ; adverse effects ; Male ; Middle Aged ; Peripheral Nerve Injuries ; etiology ; prevention & control ; Postoperative Complications ; Rectal Neoplasms ; surgery ; Sexual Dysfunction, Physiological ; etiology ; Urologic Diseases ; etiology