The aim of this thesis was to evaluate the intriguing and relevant relationship between UI and FSD in urological practice. This relationship is addressed from anatomical, clinical and health care... Show moreThe aim of this thesis was to evaluate the intriguing and relevant relationship between UI and FSD in urological practice. This relationship is addressed from anatomical, clinical and health care points of view. The initial question was whether urologists should play a role in sexual health care of women with urinary incontinence. In chapter 2, three-dimensional anatomical econstructions and results of dissection in cadavers are described. The reconstructions illustrate the clitoral innervation in order to deduce its anatomical relationship to other pelvic structures. This is important to preserve clitoral nerves during pelvic surgery. Furthermore, this chapter evaluates the possible effects of incontinence surgery from an anatomical point of view, especially with regards to the nerves important for sexual function. In chapter 3, sexual function is evaluated among women after a sling procedure. This study attempts to clarify the impact of surgery for stress urinary incontinence on female sexual function. In addition, the relevance of the presence of preoperative coital incontinence is discussed extensively. Chapter 4 discusses the impact of female urinary incontinence on the sexual relationship with male partners. The chapters 5 and 6 overview practices, attitudes and believes of Dutch urologists towards FSD and sexual abuse. Chapter 7 analyses how Dutch incontinence nurses deal with sexuality and sexual abuse in their daily practice. Finally, chapter 8 provides a __helicopter view__ on data of this of this thesis followed by a discussion on future prospects. Show less
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... Show moreIntroduction. 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 à 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. Show less
Bladder perforation is a complication which can occur after a ProliftA (R) procedure and may enhance vesicovaginal fistula formation. Different methods of management of bladder perforation caused... Show moreBladder perforation is a complication which can occur after a ProliftA (R) 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. Show less
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... Show moreIntroduction. 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. Show less
