Андрология и генитальная хирургия. 2024; 25: 110-119
Состояние сексуальной функции у пациентов с новообразованием яичка до проведения специализированных методов лечения. Клиническое исследование
https://doi.org/10.62968/2070-9781-2024-25-2-110-119Аннотация
Введение. Новообразования яичек (НЯ) – одно из наиболее распространенных онкологических заболеваний мужчин молодого возраста. В настоящее время сексуальная функция у этих пациентов остается недостаточно изученной.
Цель исследования. Оценить состояние сексуальной функции у мужчин с новообразованиями яичек до начала лечения.
Материалы и методы. В исследование включено 35 мужчин с НЯ, средний возраст 34,2±8,2 года. Группу сравнения составили 28 здоровых добровольцев, средний возраст – 30,5±4,9 года. Оценивались социальные характеристики пациента (наличие брака и детей) и индекс массы тела (ИМТ), состояние сексуальной функции (с помощью опросников МИЭФ-15 и МКФ), уровень тревоги и депрессии (по шкале НADS), уровни общего и свободного тестостерона (Т), глобулина, связывающего половые гормоны (ГСПГ), фолликулостимулирующего гормона (ФСГ), лютеинизирующего гормона (ЛГ) и пролактина (ПРЛ).
Результаты. В группе исследования у 10 (28,6%) пациентов отмечалось снижение эрекции, у 12 (34,3%) – неудовлетворенность половым актом, у 2 (5,7%) – нарушение оргазмической функции, у 9 (25,7%) – снижение либидо и общей удовлетворенности половым актом. Также отмечено статически значимое снижение либидо (p < 0,05), удовлетворительности половым актом (p < 0,05) и общей удовлетворительности половым актом (p = 0,007) по сравнению с контрольной группой. Нарушения психической составляющей полового акта наблюдались у 12 (34,3%), эрекционной – у 20 (57,1%), нейрогуморальной – у 25 (71,4%), эякуляторной – у 10 (28,6%) пациентов с НЯ. У 13 (37,1%) пациентов с НЯ наблюдалась субклиническая, у 11 (31,4%) – клинически выраженная депрессия. Тревога и депрессия статистически значимо чаще встречалась у пациентов с НЯ (p = 0,0013). Эти показатели были более выражены у пациентов, не состоящих в браке (p = 0,013) и не реализовавших репродуктивную функцию (p = 0,025). Низкий уровень общего Т определялся у 13 (39,4%), свободного Т – у 12 (38,7%), ЛГ – у 11 (33,3%), ФСГ – у 6 (18,7%) пациентов с НЯ. Повышенный уровень ЛГ зафиксирован у 4 (12,1%), ФСГ у 4 (12,5%), ПРЛ – у 2 (6,9%) и ГСПГ – у 1 (5%) пациента. Не были выявлены статически значимые различия зависимости уровня гормонов от возраста и ИМТ (p > 0,05).
Заключение. У пациентов с НЯ уже на момент установления диагноза отмечается ухудшение сексуальной функции по сравнению со здоровой популяцией той же возрастной группы. Необходимы дальнейшие исследований для оценки влияния на сексуальную функцию гистологической формы новообразования и лечения НЯ.
Список литературы
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16. Bandak M, Aksglaede L, Juul A, Rørth M, Daugaard G. The pituitary-Leydig cell axis before and after orchiectomy in patients with stage I testicular cancer. Eur J Cancer 2011;47(17):2585-91. https://doi.org/10.1016/j.ejca.2011.05.026.
17. Bandak M, Jørgensen N, Juul A, Lauritsen J, Kier MGG, Mortensen MS, et al. Longitudinal changes in serum levels of testosterone and luteinizing hormone in testicular cancer patients after orchiectomy alone or bleomycin, etoposide, and cisplatin. Eur Urol Focus 2018;4(4):591-8. https://doi.org/10.1016/j.euf.2016.11.018.
18. Petersen PM, Skakkebaek NE, Vistisen K, Rørth M, Giwercman A. Semen quality and reproductive hormones before orchiectomy in men with testicular cancer. J Clin Oncol 1999;17(3):941-7. https://doi.org/10.1200/JCO.1999.17.3.941.
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20. Bumbasirevic U, Bojanic N, Pekmezovic T, Janjic A, Janicic A, Milojevic B, et al. Health-related quality of life, depression, and sexual function in testicular cancer survivors in a developing country: a Serbian experience. Support Care Cancer 2013;21(3):757-63. https://doi.org/10.1007/s00520-012-1577-6.
21. Dahl AA, Haaland CF, Mykletun A, Bremnes R, Dahl O, Klepp O, et al. Study of anxiety disorder and depression in long-term survivors of testicular cancer. J Clin Oncol 20051;23(10):2389-95. https://doi.org/10.1200/JCO.2005.05.061.
22. Dahl AA, Bremnes R, Dahl O, Klepp O, Wist E, Fosså SD. Is the sexual function compromised in long-term testicular cancer survivors? Eur Urol 2007;52(5):1438-47. https://doi.org/10.1016/j.eururo.2007.02.046.
23. Darabos K, Hoyt MA. Masculine norms about emotionality and social constraints in young and older adult men with cancer. J Behav Med 2017;40(2):259-70. https://doi.org/10.1007/s10865-016-9739-5.
24. Grov EK, Fosså SD, Bremnes RM, Dahl O, Klepp O, Wist E, et al. The personality trait of neuroticism is strongly associated with long-term morbidity in testicular cancer survivors. Acta Oncol 2009;48(6):842-9. https://doi.org/10.1080/02841860902795232.
25. Smith AB, Butow P, Olver I, Luckett T, Grimison P, Toner GC, et al. The prevalence, severity, and correlates of psychological distress and impaired health-related quality of life following treatment for testicular cancer: a survivorship study. J Cancer Surviv 2016;10(2):223-33. https://doi.org/10.1007/s11764-015-0468-5.
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Andrology and Genital Surgery. 2024; 25: 110-119
Sexual function in patients with testicular neoplasm before specialized treatment methods. Clinical trial
https://doi.org/10.62968/2070-9781-2024-25-2-110-119Abstract
Introduction. Testicular neoplasms (TN) are one of the most common oncological diseases among young men. Currently the sexual function of such patients remains understudied. The aim of the study was to assess the state of sexual function in men with testicular neoplasms before treatment.
Material and methods. The cross-sectional continuous single-center study included 35 men with TN. The average age of patients was 34.2–8.2 years (95% CI: 31.4-37.1). The comparison group included 28 healthy volunteers, average age 30.5–4.9 years (95% CI: 28.6-32.4). Some social characteristics of the patient (marriage and children), the state of sexual function (using the IIEF-15 and ICF questionnaires), the level of anxiety and depression (according to the HADS scale), the levels of total and free testosterone, globulin-binding sex hormone (SHBG), follicle-stimulating hormone (FSH), luteinizing hormone (LH) and prolactin were evaluated.
Results. Patients in the main group showed a decrease in erection in 10 (28.6%), satisfaction with sexual intercourse in 12 (34.3%), impaired orgasmic function in 2 (5.7%), decreased libido and overall satisfaction in 9 (25.7%). Nonparametric analysis revealed a statistically significant decrease in libido (p < 0.05), satisfaction with sexual intercourse (p < 0.05) and overall satisfaction (p = 0.007) in patients of the main group compared with the control group. Patients with testicular neoplasms had disorders of the mental component – in 12 (34.3%), erection – in 20 (57.1%), neurohumoral – in 25 (71.4%), ejaculatory – in 10 (28.6%) patients. Subclinical depression was observed in 13 (37.1%) and clinically pronounced depression in 11 (31.4%) patients of the main group. Anxiety and depression were statistically significantly more common in the main group (p = 0.0013). The level of anxiety and depression was more pronounced in unmarried (p = 0.013) children-free patients (p = 0.025). Low levels of total testosterone were detected in 13 (39.4%), free testosterone in 12 (38.7%), LH in 11 (33.3%), FSH in 6 (18.7%) patients from the main group. Elevated levels of LH were recorded in 4 (12.1%), FSH in 4 (12.5%), prolactin in 2 (6.9%) and SHBG in 1 (5%).
Conclusion. Patients with TN have a deterioration in sexual function compared to a healthy population of the same age group. The further studies are needed to access the influence of tumor histology and treatment of sexual function.
References
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15. Wiechno PJ, Kowalska M, Kucharz J, Sadowska M, Michalski W, Poniatowska G, et al. Dynamics of hormonal disorders following unilateral orchiectomy for a testicular tumor. Med Oncol 2017;34(5):84. https://doi.org/10.1007/s12032-017-0943-0.
16. Bandak M, Aksglaede L, Juul A, Rørth M, Daugaard G. The pituitary-Leydig cell axis before and after orchiectomy in patients with stage I testicular cancer. Eur J Cancer 2011;47(17):2585-91. https://doi.org/10.1016/j.ejca.2011.05.026.
17. Bandak M, Jørgensen N, Juul A, Lauritsen J, Kier MGG, Mortensen MS, et al. Longitudinal changes in serum levels of testosterone and luteinizing hormone in testicular cancer patients after orchiectomy alone or bleomycin, etoposide, and cisplatin. Eur Urol Focus 2018;4(4):591-8. https://doi.org/10.1016/j.euf.2016.11.018.
18. Petersen PM, Skakkebaek NE, Vistisen K, Rørth M, Giwercman A. Semen quality and reproductive hormones before orchiectomy in men with testicular cancer. J Clin Oncol 1999;17(3):941-7. https://doi.org/10.1200/JCO.1999.17.3.941.
19. Alacacioglu A, Ulger E, Varol U, Yavuzsen T, Akyol M, Yildiz Y, et al. Sexual satisfaction, anxiety, depression and quality of life in testicular cancer survivors. Medical Oncology 2014;(31)7:43. https://doi.org/10.1007/s12032-014-0043-3
20. Bumbasirevic U, Bojanic N, Pekmezovic T, Janjic A, Janicic A, Milojevic B, et al. Health-related quality of life, depression, and sexual function in testicular cancer survivors in a developing country: a Serbian experience. Support Care Cancer 2013;21(3):757-63. https://doi.org/10.1007/s00520-012-1577-6.
21. Dahl AA, Haaland CF, Mykletun A, Bremnes R, Dahl O, Klepp O, et al. Study of anxiety disorder and depression in long-term survivors of testicular cancer. J Clin Oncol 20051;23(10):2389-95. https://doi.org/10.1200/JCO.2005.05.061.
22. Dahl AA, Bremnes R, Dahl O, Klepp O, Wist E, Fosså SD. Is the sexual function compromised in long-term testicular cancer survivors? Eur Urol 2007;52(5):1438-47. https://doi.org/10.1016/j.eururo.2007.02.046.
23. Darabos K, Hoyt MA. Masculine norms about emotionality and social constraints in young and older adult men with cancer. J Behav Med 2017;40(2):259-70. https://doi.org/10.1007/s10865-016-9739-5.
24. Grov EK, Fosså SD, Bremnes RM, Dahl O, Klepp O, Wist E, et al. The personality trait of neuroticism is strongly associated with long-term morbidity in testicular cancer survivors. Acta Oncol 2009;48(6):842-9. https://doi.org/10.1080/02841860902795232.
25. Smith AB, Butow P, Olver I, Luckett T, Grimison P, Toner GC, et al. The prevalence, severity, and correlates of psychological distress and impaired health-related quality of life following treatment for testicular cancer: a survivorship study. J Cancer Surviv 2016;10(2):223-33. https://doi.org/10.1007/s11764-015-0468-5.
26. Tuinman MA, Hoekstra HJ, Vidrine DJ, Gritz ER, Sleijfer DT, Fleer J, et al. Sexual function, depressive symptoms and marital status in nonseminoma testicular cancer patients: a longitudinal study. Psychooncology 2010;19(3):238-47. https://doi.org/10.1002/pon.1560.
