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SamenvattingEen terugkerend urologisch dilemma is of bij mannen een cystolithotripsie gecombineerd moet worden met een transurethrale resectie van de prostaat (TURP), om een blaassteenrecidief te voorkomen en steenlozing te faciliteren. Er zijn aanwijzingen dat ook zonder gelijktijdige TURP het percentage recidieven klein is. In dit retrospectieve multicenteronderzoek is nagegaan wat de waarde is van een TURP in deze context. In totaal werden in vijf centra 127 patiënten geïncludeerd. TURP ten tijde van de cystolithotripsie lijkt een bescheiden beschermend effect te hebben op de middellange termijn (NNT = 7). Van de patiënten die niet gelijktijdig een TURP ondergingen, bleef 81 % op middellange termijn vrij van een recidief. Wat ons betreft geldt gezamenlijke besluitvorming als het nieuwe adagium bij mannen met blaasstenen.

Objectives To evaluate possible discrepancies between patients’ expectations concerning sexual side effects related to prostate cancer treatment, based on the obtained information prior to treatment. Moreover, to determine if demographic or clinical factors may have an effect on the accuracy of patients’ expectations concerning sexual side effects after treatment. Methods A multicenter, cross-sectional survey was performed among men treated with prostatectomy, brachytherapy, external-beam radiotherapy and/or hormonal therapy. Results In total, 412 questionnaires were analyzed. Of men with sexual side effects after treatment, 1 in 3 (32.5%, n = 109) reported their complaints as worse than expected; significantly more often reported by men treated surgically (P = .001), men with a local stage tumor (P = .005) and by men with a lower prostate-specific antigen level at diagnosis (P = .046). It was significantly less often reported by men treated with radiotherapy combined with hormonal therapy (P = .031). Men who used brochures as an information source reported their sexual side effects significantly less often as worse than expected (P Conclusion One in three men with sexual side effects after prostate cancer treatment, experienced their complaints as worse than expected based on the obtained information prior to treatment. Men treated with radiotherapy combined with hormonal therapy indicated less discrepancy between expectations and developed sexual side effects, whereas prostatectomy, low stage tumor and low prostate-specific antigen level were associated with more discrepancy. Brochures should be administered additionally to verbal information to improve patients’ understanding of possible sexual side effects and to enhance the accuracy of patients’ expectations.

A cross-sectional survey was performed among partners and men who received treatment for prostate cancer to investigate whether demographic and clinical characteristics are associated with the extent of how difficult partners found it dealing with sexual side effects and the degree of having experienced sexual problems after treatment. Moreover, an aim was to determine whether sexual side effects have an impact on the relationship. A total of 171 partners were included. In all, 104 men (70.7%) experienced an increase in erectile complaints after treatment. Almost half of partners of men with an increase in erectile complaints (63.6%, n = 63) found it difficult to deal with sexual side effects and 63.5% (n = 66) experienced sexual problems. Partners with lower education levels experienced fewer sexual problems than partners with higher education levels (p

Erectiele disfunctie (ED) is een van de meest voorkomende gevolgen van prostaatkankerbehandeling en kan leiden tot verandering in een partnerrelatie. Doel van deze studie was het inventariseren van seksuologische en/of relationele problemen en onderzoeken welke vorm van aanvullende zorg gewenst wordt door patient en partner. Dit vond plaats middels een vragenlijstonderzoek onder mannen gediagnosticeerd met prostaatkanker onder active surveillance of behandeld met laparoscopische radicale prostatectomie, brachytherapie, intensiteitsgemoduleerde radiotherapie of hormonale therapie. Indien mogelijk werden partners geincludeerd. Van 250 patienten had 80,5 % last van matig tot ernstige erectieklachten. De helft (53,7 %) werd behandeld voor ED, waarbij een derde (30,7 %) deels tevreden was en een kwart (25,7 %) ontevreden. Van 168 partners had 50,6 % moeite met de veranderingen rond seksualiteit. De meerderheid van de mannen (74,7 %) zou het wenselijk vinden om drie maanden na behandeling tijdens een standaardconsult seksualiteit te bespreken met een uroloog-seksuoloog.

The current urology training lacks education in sexual medicine. This was demonstrated by a nationwide cross-sectional survey among urologists in training, conducted in June 2015. Regardless of the residency year, most of the residents had never attended training about sexual dysfunction (58.–6 %), possessed little knowledge (48.3 %) and reported a clear need for more education (69.4 %). The majority felt not competent in treating patients with sexual dysfunctions after prostate cancer treatment (55.2 %). Time constraints in a consultation (67.1 %) and lack of education (35.3 %) were the most frequently cited barriers. More than half of the residents reported that the program does not provide sufficient education about sexual dysfunction (54.8 %). Consequently, the results of this survey support efforts to improve the urology program regarding education about prostate cancer-related sexual dysfunction.

Objective To assess urology residents' current knowledge, practice, previous training, barriers, and training needs regarding prostate cancer treatment-related sexual dysfunction. Materials and Methods A cross-sectional questionnaire study inventoried the practice patterns and training need of urology residents attending a national training course in June 2015. Results Of 101 urology residents throughout the Netherlands, 87 attended the training (response rate 100%). Median age was 32 years (range 28-38); 55.2% were woman. Regardless of the residency level, most trainees had never received education about sexual dysfunction (58.6%), reported a limited level of knowledge (48.3%), and indicated an evident need for training (69.4%). The majority did not feel competent to advise prostate cancer patients regarding the treatment of sexual dysfunction (55.2%). Almost all participants inquired about preoperative erectile dysfunction (89.7%), and always informed about treatment-related sexual dysfunction (88.5%). At follow-up, 63.9% of the residents routinely addressed sexual complaints again. More than half of the participants indicated that urology residency training does not provide sufficient education on sexual dysfunction (54.8%).Time constraint (67.1%) and lack of training (35.3%) were the most frequently mentioned barriers. Conclusion Current urology residency does not pay sufficient attention to sexual communication skills and sexual dysfunction. The residents require more knowledge about and more practical training in sexual counseling. Findings support efforts to enhance the education of urology residents regarding prostate cancer treatment-related sexual dysfunction.

A 64-year-old man was referred to our urology outpatient clinic with lower urinary tract symptoms (LUTS). During rectal examination a smooth nodule was identified. MRI-images showed a prostatic cyst, originating from the utriculus. An utriculus cyst is a relatively rare finding and originates from a persistent remnant of the Müllerian duct.

Purpose.To determine which health care provider and what timing is considered most suitable to discuss sexual and relational changes after prostate cancer treatment according to the point of view of men and their partners.Methods.A cross-sectional survey was conducted among men diagnosed with prostate cancer or treated after active surveillance, who received laparoscopic radical prostatectomy, brachytherapy, intensity-modulated radiotherapy, and/or hormonal therapy. If applicable, partners were included as well.Results.In this survey, 253 men and 174 partners participated. Mean age of participating men was 69.3 years (SD 6.9, range 45-89). The majority (77.8%) was married and average length of relationship was 40.3 years (SD 14.1, range 2-64). Out of 250 men, 80.5% suffered from moderate to severe erectile dysfunction. Half of them (50.2%, n = 101) was treated for erectile dysfunction and great part was partially (30.7%, n = 31) up to not satisfied (25.7%, n = 26). Half of the partners (50.6%, n = 81) found it difficult to cope with sexual changes. A standard consultation with a urologist-sexologist to discuss altered sexuality is considered preferable by 74.7% (n = 183). Three months after treatment was the most suitable timing according to 47.6% (n = 49).Conclusions.During follow-up consultations, little attention is paid to the impact of treatment-induced sexual dysfunction on the relationship of men with prostate cancer and their partners. A standard consultation with a urologist-sexologist 3 months after treatment to discuss sexual and relational issues is considered as most preferable.