British Journalof Urology (1992), 70,33-39

01992 British Journal of Urology

Male and Female Sexual Function and Activity Following Ileal Conduit Urinary Diversion G. M.NORDSTROM and C. R. NYMAN Department of Urology, Sodersjukhuset, Stockholm, Sweden

Summary-A group of 6 6 patients (40males, 26 females) underwent an ileal conduit urinary diversion because of bladder cancer (44 patients) or incontinence/bladder dysfunction (22). They were questioned about pre- and post-operative sexual function and activity and it was found that 90% of the males (26/29) who were sexually active before surgery lost the ability to achieve erection following radical cystectomy. Although they were unable to achieve penile erection, 4 1% were able to experience orgasm by means of masturbation. Five of the 29 males received penile implants. Five of the 6 females treated by cystectomy, who were sexually active before the operation, reported either a decrease or cessation of sexual activity (i.e. coitus) post-operatively. The main problems were a decrease in sexual desire, dyspareunia and vaginal dryness. One women reported the inability to experience orgasm after surgery. Compared with women with bladder cancer, those with incontinence/bladder dysfunction were more likely to have an active sexual life after urostomy surgery. Seven females in this group, of whom 4 were sexually inactive before surgery, increased their sexual activity after the operation. For these women the conduit operation removed the need to use incontinence pads or indwelling catheters.

In the present study special attention has been paid to the extent to which gender, diagnosis and surgical procedure have influenced sexual function and activity.

Although the creation of an ileal conduit has been the most common procedure for urinary diversion over the last 40 years (Bricker, 1950), there is little information about sexual function and activity following urostomy surgery. The high risk of sexual impotence following cystectomy was reported by Romanus (1948) and subsequent studies describe sexual impotence following radical cystectomy for bladder cancer in approximately 90% of male patients (Bergman et al., 1979; Schover et a[., 1986). Compared with males, the sexual consequences for females following this operation seem to be less drastic. Schover and Eschenbach (1985) reported that most females resumed sexual activity, although they experienced some degree of vaginal dryness, tightness and pain. However, both physical and emotional factors, such as a decrease in sexual attractiveness, may influence sexual life following ostomy surgery (Gloeckner, 1984; Boyd et al., 1987).

Patients and Methods Sexual function and activity were investigated in 66 patients (40 males and 26 females); 44 patients had undergone ileal conduit urinary diversion as a result of carcinoma of the bladder (Table 1). Forty patients (31 males, 9 females) had received preoperative radiotherapy (36 Gy 4-6 weeks before the operation or 20 Gy 1week before) and 3 patients (2 males, 1 female) had received radiotherapy at an earlier stage. In 1 woman the cystectomy was performed without previous irradiation. Incontinence/bladder dysfunction led to urinary diversion in 22 patients (Table 2). The age distribution at operation was 20 to 76 years (mean 55). The time that had elapsed since surgery ranged from 3 to 14 years (mean 7).

Accepted for publication 7 August 1991




Table 1 Type of Surgery in 44 Patients with Bladder

Cancer Type of surgery

Urinary diversion Cystectomy Prostatectomy Vesiculectomy Urethrectomy Hysterectomy Salpingectomy Oophrectomy Vaginal resection

Males (n=33)


33 32 32 32 30

11 11





11 2 2 0 1

Total (n=44)

44 43 32 32 41 2 2 0 1

A detailed description of the selection of patients is presented by Nordstrom et al. (1990). An interview comprising open-ended and closed questions was used for data collection. The questionnaire was based on studies by Bergman et al. (1979), Jones et al. (1980), Studer and Furger (1981) and our own clinical experience. The questions concentrated on pre- and post-operative sexual function and activity and covered the following topics : sexual desire, erection, frequency of coitus, coital and non-coital ability to experience orgasm, causes of increased or decreased sexual activity and overall satisfaction with sexual life. All interviews were performed by the same enterostomal therapy nurse (G.N.) either at the Stoma Care Unit, Sodersjukhuset (57 patients) or in the patient’s home (9 patients). Supplementary details regarding diagnosis, surgical technique and treatment were taken from the patient’s medical records. Statistical calculations were performed according to the SAS program package. Owing to the small

number of patients in some categories, Fisher’s exact test was used after condensing the data into 4-fold tables. For analysis of 2 dependent groups, the McNemar test for the significance of changes was used (Siegel, 1956; Iverson Shelly, 1984). All hypotheses were tested by 2-tailed tests; P

Male and female sexual function and activity following ileal conduit urinary diversion.

A group of 66 patients (40 males, 26 females) underwent an ileal conduit urinary diversion because of bladder cancer (44 patients) or incontinence/bla...
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