Type of Surgery for Bladder Cancer May Impact Sexual Function

Women with bladder cancer who undergo reproductive organ sparing radical cystectomy (complete removal of the bladder) may be more likely to experience sexual dysfunction compared with those who undergo a non-reproductive organ sparing surgery, recent study findings demonstrated.

Although the difference between both groups was not statistically significant, researchers hypothesize that the increase in sexual dysfunction in women who underwent reproductive organ sparing radical cystectomy may be due to this group being more sexually active before surgery, according to results presented at the Society of Urologic Oncology 22nd Annual Meeting.

However, the small number of patients surveyed in the study indicates that more research must be done to confirm whether such results are significant or not, according to Sajya M. Singh, co-author of the study and a fourth-year medical student from Johns Hopkins University School of Medicine in Baltimore.

Studies like this illustrate the need for women with bladder cancer to discuss sexual function with their cancer teams when making treatment decisions, explained Singh in an interview with CURE®.

Sparing Reproductive Organs for Patients

Singh explained that in the past, patients who underwent surgery for bladder cancer also had other pelvic organs removed including the ovaries

“Historically, (this was) done because (doctors believed that) that bladder cancer, especially in advanced stage disease, could spread to those organs due to their close proximity within the pelvis,” Singh said.

However, according to Singh, studies have demonstrated that the rate at which bladder cancer spreads to these organs is low, especially for patients with non-muscle invasive disease (cancer that is found in the bladder tissue instead of bladder muscles).

“(Researchers) have also shown that, when the reproductive organs (are spared), we don't see increases in overall mortality or recurrence risk of cancer in patients,” Singh said.

As a result, more patients have received reproductive organ-sparing cystectomies, sparking a need to study if such surgeries influence sexual function, which can be a significant indicator of quality of life for many patients.

Surveying Patients

Singh and her colleagues surveyed 45 women with bladder cancer who underwent surgery to remove their bladder between 2016 and 2020. Of those 45 patients, 14 had their reproductive organs removed and 31 did not. Prior to the surgery, more women in the reproductive organ-sparing group were sexually active than in the group of women who had their reproductive organs removed. However, after the surgery, there was no difference in sexual function noted between the two groups.

The Importance of Speaking with Providers

"There are options for people who are interested in retaining their sexual function. Quality of life is super important for patients," said Sajya M. Singh, a fourth-year medical student from Johns Hopkins University School of Medicine in Baltimore.

Singh stated that these results highlight the need for more discussions about preserving sexual function among patients with bladder cancer and urged patients to speak to their urologists if preserving sexual function is a priority to them.

“There are options out there for people who are interested in retaining their sexual function,” explained Singh. “Obviously, we want to do what's best for (eliminating) the cancer, but quality of life is super important for patients.”

While the study did not assess gender of the patients’ urologists, Singh mentioned that is possible the gender disparities in the field of urology may play a role in women not always speaking to their doctors about sexual function. Of note, the American Urological Association 2020 census found that women accounted for only 10.3% of all practicing urologists in the United States.

‘A Lot Left to Learn’

Singh explained that she hopes to replicate the study in a prospective manner, which is where researchers follow patients inreal-timee rather than asking them to recall a surgery that happened years ago. With this approach, she hopes to be able to ask women about their sexual function prior to surgery, after the surgery and collect data over time.

Singh also hopes to consider the age of patients in future research.

“Bladder cancer is a disease of older people,” she said. “Most women in our studies were in their 60s and 70s. Few — only 12 of our 45 patients — were sexually active. And (some) women mentioned that they had no interest in sex, which is totally fine, (but something) we do need to be conscious of.”

Singh concluded by stressing that this study must be replicated with a larger patient population, as this study was conducted in a limited group of patients. “I think there's still a lot left to learn,” she said. “We’re adding to the literature here in terms of sexual function.”

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