Transurethral and suprapubic mesh resection after Prolift® bladder perforation: a case report

Bladder perforation is a complication which can occur after a Prolift® procedure and may enhance vesicovaginal fistula formation. Different methods of management of bladder perforation caused by mesh procedures are described in the literature, and most authors advise complete excision of the mesh. In the case described in this article, we propose a combined transurethral and suprapubical approach as the optimal method for maximal tape removal, being both minimally invasive and less damaging to the vesical wall. A suprapubical catheter can be removed shortly after surgery to enable optimal tissue healing of the vesical mucosa

How Do Continence Nurses Address Sexual Function and a History of Sexual Abuse in Daily Practice? Results of a Pilot Study

Introduction. There is a strong association between urological complaints, sexual dysfunction, and history of sexual abuse (SA), and it is unknown whether urological continence nurses integrate this knowledge in their daily practice. Aim. To evaluate how, in their daily practice, Dutch urological continence nurses address sexual dysfunction and possible SA. Methods. An anonymous 19-item questionnaire was distributed among all Dutch urinary continence nurses visiting their yearly congress. Main Outcome Measures. The survey results. Results. The response rate was 48.9% (93/190). Of the respondents, 11.8% did not ask their female patients about sexual function; 37.6% asked only rarely; 44.1% asked often; and 6.5% always asked. Sexual functioning in males was not evaluated by the majority of the nurses (13.2% never, and 46.2% rarely). A minority of continence nurses asked males about sexual functioning (36.3% often and 4.3% always). Important reasons for not asking were insufficient knowledge of how to adequately ask males (38.9%) and females (47.8%) about sexual problems, and because nurses assumed the urologist had addressed this issue (48.1% asking males, 39.1% asking females). Younger nurses found it particularly difficult to raise sexual issues with both male and female patients (P = 0.001 and P = 0.003, respectively). Screening for sexual dysfunction was stated to be important by almost all nurses (65.2% "quite important," and 31.5% "very important"). Within their patient population, both male and female, 28% of the nurses never asked about SA and 49.5% asked only rarely. Conclusion. Dutch urological incontinence nurses acknowledge the importance of sexual problems in their patient population, but asking about this issue was not part of routine care. The main reasons for not asking, according to the nurses' responses, were that they had insufficient knowledge and that they assumed the urologist had already asked about sexual problems. Bekker MD, Van Driel MF, Pelger RCM, Lycklama a Nijeholt GAB, and Elzevier HW. How do continence nurses address sexual function and a history of sexual abuse in daily practice? Results of a pilot study. J Sex Med 2011;8:367-375

Prevalence of Sexual Abuse among Patients Seeking General Urological Care

Introduction. Sexual abuse (SA) history can be found in the backgrounds of an important fraction of men (8-10%) and women (12-25%). Until now there are no data about this prevalence within a urological patient population. Aim. To establish the prevalence of SA among men and women visiting a urological outpatient clinic and to assess their opinion on screening for SA by urologists. Methods. A questionnaire to identify SA was translated into Dutch, English, and Turkish, and was adjusted for use in men. These questionnaires were anonymously distributed among 1,016 adult patients attending the urological outpatient clinic. Main Outcome Measure. The self-reported prevalence of SA. Secondary outcome measures were data about the assailant, victim's age at the time of the abuse, if the abuse was disclosed to the urologist, if the urologist had asked for SA, and patient opinions on standard screening for SA in urological care. Results. A total of 878 questionnaires were returned, giving a total response rate of 86.4% (878/1,016). Thirty-three patients refused to participate. This resulted in 845 filled-out questionnaires suited for analysis (845/1,016 = 83.2%). There were more male (75.7%) than female respondents (21.8%); 2.1% (13/624) and 13.0% (21/161) of the male and female respondents reported a history of SA, respectively. Almost 42% reported a stranger as assailant. In nearly 90%, the SA took place before adulthood: 56.2% in childhood and 31.2% in adolescence. Fifteen percent of the respondents with SA had it disclosed to their urologist. More than 70% of the abused respondents considered the idea to screen for SA in urological practice to be a good one. Conclusions. The prevalence of SA in patients seeking urological care in the Netherlands is 2.1% for men and 13.0% for women. Beck JJH, Bekker MD, van Driel MF, Roshani H, Putter H, Pelger RCM, and Elzevier HW. Prevalence of sexual abuse among patients seeking general urological care. J Sex Med 2011; 8: 2733-2738

Sexual Abuse History in GI Illness, How Do Gastroenterologists Deal with It?

Introduction. Data support an increased prevalence of sexual abuse (SA) among patients with gastrointestinal (GI) complaints. Sexual abuse causes multiple symptoms related to pelvic floor and stress mediated brain-gut dysfunctions. Treating these patients asks for a holistic approach, using centrally targeted interventions. However, gastroenterologists have never been surveyed regarding their practice patterns and constraints about inquiring into SA. Aim. To evaluate whether gastroenterologists address SA in their daily practice and to evaluate their knowledge regarding the implications of SA in GI illness. Methods. A 42-item anonymous questionnaire was mailed to all 402 members of the Dutch Society of Gastroenterology (gastroenterologists and fellows in training). The questionnaire addressed SA and pelvic-floor-related complaints. Main Outcome Measures. The results of this survey. Results. One hundred eighty-three of the 402 (45.2%) questionnaires were returned. Overall, 4.7% of the respondents asked their female patients regularly about SA; in males, this percentage was 0.6%. Before performing a colonoscopy, these percentages were even smaller (2.4% and 0.6%, respectively). When patients presented with specific complaints, such as chronic abdominal pain or fecal incontinence, 68% of the gastroenterologists asked females about SA and 29% of the males (P <0.01). The majority of respondents stated it as rather important to receive more training on how to inquire about SA and its implications for treatment. Conclusion. Gastroenterologists do not routinely inquire about a history of SA and they rarely ask about it before performing colonoscopy. There is a need for training to acquire the skills and knowledge to deal with SA. Nicolai MPJ, Fidder HH, Beck JJ, Bekker MD, Putter H, Pelger RCM, van Driel MF, and Elzevier HW. Sexual abuse history in GI illness, how do gastroenterologists deal with it? J Sex Med 2012;9:12771284

Sexual Experiences of Men with Incontinent Partners

Introduction. Several studies show that urinary incontinence (UI) impairs women's sexual functioning and sexual satisfaction. However, there is no scientific knowledge about the effects of UI on sexual functioning of the male partners. Aim. To analyze sexual functioning of the male partners of females with UI. Methods. During a period of 2.5 years all new female patients and their partners (both groups aged 18 years and older), who presented at our outpatient clinic for urological evaluation, were asked for demographic characteristics, medical history, and referral indication including the main urological complaint. In addition they were asked to fill in the Golombok Rust Inventory of Sexual Satisfaction questionnaires about sexual functioning. Main Outcome Measures. Sexual function measured by the Golombok Rust Inventory of Sexual Satisfaction questionnaire. Results. A total of 189 sexually active couples completed the questionnaires. Eighty-one (42.9%) of the women had UI as main urological complaint. Differences were found between women with UI and those without. Women with UI have a lower overall sexual function (P = 0.02), lower frequency of intercourse (P = 0.02), more problems with communication (P = 0.036), and more often show avoidable behavior with regard to sexual activity. (P = 0.002) Men with partners with UI showed a diminished overall sexual function (6.66 +/- 1.53) compared with men with women without UI (5.95 +/- 1.22, P = 0.001). Furthermore, comparisons of subscales also demonstrate a lower frequency of intercourse (5.62 +/- 2.00, 6.49 +/- 1.96), less satisfaction (8.08 +/- 2.79, 9.69 +/- 3.63), and more erectile problems (6.01 +/- 2.28, 6.87 +/- 3.23) in men with partners with UI. (P = 0.03, P = 0.001, P = 0.037) Conclusions. This study shows that female urinary incontinence correlates with their partners' overall sexual functioning and sexual satisfaction. In addition, significant differences were found with regard to the satisfaction with one's sex life between a woman with UI and her partner. Bekker MD, Beck JJH, Putter H, van Driel MF, Pelger RCM, Weijmar Schultz WC, Lycklama a Nijeholt GAB, and Elzevier HW. Sexual experiences of men with incontinent partners. J Sex Med 2010;7:1877-1882