(UroToday.com) Dr. Svetlana Avulova, MD is a urologic oncologist at Albany Medical Center in Albany, NY. She is the recipient of the 2021 BCAN Patient-Centered Clinical Young Investigator Award for her research focused on characterizing sexual function in females undergoing radical cystectomy.
Traditional anterior pelvic exenteration operative templates for radical cystectomy in females include removal of the bladder, urethra, uterus, ovaries and anterior vaginal wall. The benefits of female pelvic organ preservation were fortuitously described during efforts to improve neobladder outcomes through tissue preservation. Despite recent data suggesting low incidence of direct tumor extension or occult primary malignancies in female pelvic organs, there has been slow adoption of female organ preservation in available guidelines.
The aims of this study were to characterize changes in sexual function within one year following radical cystectomy in females, identify predictors of post-operative sexual function recovery, and describe pre-operative patient expectations regarding sexual function recovery. These are heavily hypothesized to be influenced by both patients factors (age, pre-operative sexual function, menopausal status, hormone replacement therapy, partner status, physical and psychosocial wellbeing) as well as surgical factors (pelvic organ sparing, operative approach, diversion technique, nerve sparing, vaginal closure, and pre-operative counseling).
The investigators used the PROMIS Brief Profile of Sexual Function and Satisfaction, which included the following components: interest in sexual activity, vaginal lubrication, vaginal discomfort, and satisfaction with sex life. This patient reported outcome is multifaceted as it has been implemented in a pan-cancer approach and can be directly compared with results from the general population. Dr. Svetlana shared interim results from 79 patients who enrolled and completed the baseline survey, with 23 patients completing a 12-month follow-up survey post-cystectomy.
The majority of women surveyed stated it was important to them to engage in post-cystectomy sexual activity. Nearly two-thirds of women denied having sexual intercourse within 30 days of the baseline survey, with lack of interest being the overwhelming factor. Notably, three-quarters of patients surveyed stated that their physician never discussed the ramifications of radical cystectomy on their sexual health.
The investigators measured changes from baseline in several facets of sexual health. Interest in sexual activity was generally low at baseline and remained stably low post-operatively. Importantly, satisfaction with sex life initially decreased after cystectomy, but at 12-months increased to above pre-operative baseline.
The authors concluded that post-operative sexual function is important to most patients, but the vast majority do no receive pre-operative counseling on sexual dysfunction from their urologists. Due to small patient numbers having completed the 12-month survey in this interim analysis, no meaningful conclusions could be made regarding predictors of post-operative sexual recovery, and we eagerly await these results as the data matures. Further investigation into the role of neoadjuvant and adjuvant systemic therapy as well as cancer outcomes on sexual function will further shed light on this important topic.
Written by: Patrick Hensley, MD, Urologic Oncologist at the University of Kentucky (@pjhensley11) with Ashish Kamat, MD, Urologic Oncologist at MD Anderson Cancer Center (@UroDocAsh) during the 2022 Bladder Cancer Advocacy Network Think Tank (#BCANTT22) Wednesday, Aug 3 – Friday, Aug 5, 2022
Presented by: Dr. Svetlana Avulova, MD, a urologic oncologist at Albany Medical Center in Albany, NY
1. Bree KK, Hensley PJ, Westerman ME, et al. Contemporary Rates of Gynecologic Organ Involvement in Females with Muscle Invasive Bladder Cancer: A Retrospective Review of Women Undergoing Radical Cystectomy following Neoadjuvant Chemotherapy. J Urol. 2021 Sep;206(3):577-585. doi: 10.1097/JU.0000000000001784. Epub 2021 Apr 19. PMID: 33872050.
Sexual Function in Women Undergoing Radical Cystectomy, BCAN New Discoveries Young Investigator Award for Patient-Centered Research - Svetlana Avulova