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Objective: To evaluate sexual function after treatment using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire‐Testicular Cancer 26 (EORTC QLQ‐TC26) questionnaire in Japanese testicular cancer (TC) survivors in a multi‐institutional, cross‐sectional study. Methods: This study enrolled TC survivors who visited any of eight high‐volume institutions in Japan from 2018 to 2019. After obtaining informed consent, participants completed the EORTC QLQ‐TC26 questionnaires. We evaluated sexual function after treatment for TC using the EORTC QLQ‐TC26 and analyzed the impact of treatment on sexual function in TC survivors. Results: A total of 567 TC survivors responded to the EORTC QLQ‐TC26. Median age at the time of response was 43 years (interquartile range [IQR] 35–51 years), and median follow‐up period after treatment was 5.2 years (IQR 2.2–10.0 years). Sexual function, particularly ejaculatory function, was significantly lower after post‐chemotherapy retroperitoneal lymph node dissection (PC‐RPLND) than after Surveillance or Chemotherapy groups (p < 0.05). In the PC‐RPLND group, nerve‐sparing procedure preserved postoperative ejaculatory function after RPLND compared with the non‐nerve‐sparing and offered improved ejaculatory function with time. On multivariate analysis, RPLND was a significant predictor of post‐treatment ejaculatory dysfunction, particularly without nerve‐sparing (odds ratio 3.0, 95% CI 1.2–7.7, p < 0.05). In addition, TC survivors with nerve‐sparing RPLND had higher sexual activity than those without. Conclusion: This survey of the EORTC QLQ‐TC26 showed that sexual function and activity in TC survivors after RPLND was reduced in the absence of nerve‐sparing techniques. [ABSTRACT FROM AUTHOR]

Background: The quality of life of patients is an important consideration when selecting treatments for localized prostate cancer (PCa). We retrospectively compared sexual function after robot-assisted radical prostatectomy (RARP) and carbon-ion radiotherapy (CIRT) using propensity score matching., Methods: In total, 127 Japanese PCa patients treated with RARP and 190 treated with CIRT monotherapy were evaluated. We evaluated the Expanded Prostate Cancer Index Composite (EPIC) score before treatment and 12 and 24 months after treatment. After propensity score matching, data from 101 patients from each group were analyzed. The study protocol was approved by the Institutional Review Board of Gunma University Hospital (no. IRB2020-050, 1839)., Results: After propensity score matching, the mean EPIC sexual function summary scores in the RARP and CIRT groups were 46.4 and 48.2, respectively. At 12 and 24 months after treatment, these scores were 27.9 (39.9% decrease) and 28.2 (39.2% decrease) in the RARP group and 41.4 (14.1% decrease) and 41.6 (13.7% decrease) in the CIRT group, respectively. Both groups demonstrated significantly decreased scores after 12 and 24 months of treatment compared to before treatment (all p < 0.05). At 12 and 24 months, the sexual function summary score was significantly higher in the CIRT group than in the RARP group (p < 0.001)., Conclusions: There was a smaller decrease in the EPIC sexual function score in the CIRT group than in the RARP group. These results provide useful information for treatment decision-making of Japanese PCa patients., (© 2024. The Author(s).)

Objective: This subanalysis of the VIVEVE I trial aimed to evaluate the impact of cryogen-cooled monopolar radiofrequency (CMRF) therapy, for the treatment of vaginal laxity, on the domains of sexual function included in the Female Sexual Function Index (FSFI). Materials and Methods: The VIVEVE I clinical trial was prospective, randomized, single-blind, and Shamcontrolled. Nine clinical study centers in Canada, Italy, Spain, and Japan were included. This subanalysis included premenopausal women with self-reported vaginal laxity who had -1 term vaginal delivery and a baseline FSFI total score <26.5, indicating sexual dysfunction. Enrolled subjects were randomized (2:1) to receive CMRF therapy [Active (90 J/cm²) vs. Sham (<1 J/cm²)] delivered to the vaginal tissue. Independent analyses were conducted for each FSFI domain to evaluate both the mean change, as well as the clinically important change for Active- versus Sham-treated subjects at 6 months post-intervention. Results: Subjects randomized to Active treatment (n = 73) had greater improvement than Sham subjects (n = 35) on all FSFI domains of sexual function at 6 months postintervention. The analysis of covariance change from baseline analyses showed statistically significant improvements, in favor of Active treatment, for sexual arousal ( p = 0.004), lubrication ( p = 0.04), and orgasm ( p = 0.007). In addition, Active treatment was associated with clinically important and statistically significant improvements in sexual desire [Odds ratio (OR) = 3.01 (1.11- 8.17)], arousal [OR = 2.73 (1.06-7.04)], and orgasm [OR = 2.58 (1.08-6.18)]. Conclusions: This subanalysis showed CMRF therapy is associated with statistically significant and clinically important improvements in sexual function in women with vaginal laxity. These findings provide the first randomized, placebo-controlled energy-based device evidence for functional improvements associated with a nonsurgical modality for a highly prevalent and undertreated condition. [ABSTRACT FROM AUTHOR]

Aims/Introduction To date, there is no evidence regarding the association between physical activity ( PA) and erectile dysfunction ( ED) among Japanese patients with type 2 diabetes mellitus. We investigated this issue among Japanese patients with type 2 diabetes mellitus. Materials and Methods Study participants were 460 male Japanese patients with type 2 diabetes mellitus. The definitions of exercise habit, walking habit and fast walking were based on a self-administered questionnaire regarding PA behavior. Participants were classified into one of four PA levels based on the number of 'Yes' answers to the three questions in the questionnaire: (i) lowest; (ii) lower; (iii) moderate; and (iv) higher. Severe ED and moderate-to-severe ED were based on Sexual Health Inventory for Men score <8 and <12, respectively. Results The prevalence of moderate-to-severe ED, severe ED, exercise habit, walking habit, and fast walking was 64.6, 51.1, 36.3, 41.3 and 37.6%, respectively. Walking habit was independently inversely associated with moderate-to-severe ED and severe ED. Exercise habit was independently inversely associated with severe ED, but not moderate-to-severe ED. Higher PA was independently inversely associated with moderate-to-severe ED and severe ED (adjusted odds ratio 0.42, 95% confidence interval 0.21-0.85; and adjusted odds ratio 0.38, 95% CI: 0.19-0.73, respectively). There was a statistically significant inverse exposure-response relationship between the PA level and moderate-to-severe ED and severe ED ( P for trend = 0.02 and 0.005), respectively. Conclusions PA might be inversely associated with ED in Japanese patients with type 2 diabetes mellitus. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the relationship between sexual activity and sexual function using questionnaires distributed to middle-aged Japanese patients with localized prostate cancer.Methods: A total of 145 patients who underwent radical prostatectomy were enrolled in the survey reported on herein. Sexual activity and sexual function were investigated via the Expanded Prostate Cancer Index Composite (EPIC) and an original self-reported questionnaire.Results: Of participants, 24.1% and 20.7% had sexual activity within a month period as investigated via the EPIC and original questionnaire, respectively. However, 29.7% of all those who reported sexual activity rate reported "about once every 2 months to a year," as shown in the original questionnaire. Regarding sexual function as addressed through EPIC, no results within that questionnaire's measure of sexual function showed significant differences among patients with a rate of actual sexual activity.Conclusions: The present survey showed that more than quarter of preoperative middle-aged Japanese prostate cancer patients surveyed had actual sexual activity, though not within the preceding 4 weeks. To precisely evaluate sexual function of middle-aged Japanese patients, it is necessary to consider actual sexual activity. [ABSTRACT FROM AUTHOR]

Objectives To evaluate male sexual function in Japanese prostate cancer patients undergoing permanent brachytherapy without endocrine treatment, using quality of life measures of the Expanded Prostate Cancer Index Composite. Methods A total of 482 patients were selected as analysis subjects from the nationwide database for the Japanese Prostate Cancer Outcome Study of Permanent Iodine-125 Seed Implantation. The patients were asked to complete the Expanded Prostate Cancer Index Composite questionnaires before and at 3, 12, 24, and 36 months after the permanent brachytherapy. Changes in their responses were analyzed, and any association of the outcomes was investigated. Furthermore, changes over time in their answers to Q18 (usual quality of your erections) were analyzed. Results A total of 72 patients (14.9%) had received external beam radiation. A total of 68 patients (14.1%) had taken any 5-phosphodiesterase inhibitor medications. Regarding Q18, 232 patients (48.2%) selected either 'There was no sexual activity' or 'There was no desire for erection' before receiving permanent brachytherapy. Of all the 482 patients, sexual function was preserved in 138 patients (28.7%) 3 years after permanent brachytherapy. Overall satisfaction has significantly improved without regard for the deterioration of sexual function. Significant factors for maintaining sexual activity were patient age and sexual activity before permanent brachytherapy. Conclusions In Japanese patients undergoing permanent brachytherapy alone for prostate cancer, the sexual function is not well preserved. However, decreased sexual function does not seem to represent a major factor determining patients' overall satisfaction. These findings might be peculiar to Japanese patients, in whom elderly subjects account for the majority. [ABSTRACT FROM AUTHOR]

Aims: No evidence exists regarding the association between sitting time and erectile dysfunction (ED) among patients with type 2 diabetes mellitus. The aim of this study was to evaluate the association between self-reported sitting time and ED among patients with type 2 diabetes mellitus.Methods: Study subjects were 430 male Japanese patients with type 2 diabetes mellitus (mean age, 60.5years). A self-administered questionnaire was used to collect information on the variables under study. The study subjects were asked about time spent sitting during typical 24-hour periods over the past 12months. Subjects were divided into four groups according to self-reported sitting time: 1) <5hours, 2) 5-7hours, 3) 7-9hours, and 4) ≥9hours. ED was defined as present when a subject had a Sexual Health Inventory for Men score <8. Adjustment was made for age, body mass index, duration of type 2 diabetes, current smoking, current drinking, hypertension, coronary artery disease, stroke, glycated hemoglobin, walking habit, and diabetic neuropathy.Results: The prevalence values of moderate to severe ED and severe ED were 36.1% and 49.8%. At least 9hours sitting was independently positively associated with severe ED but not moderate to severe ED; the adjusted OR was 1.84 (95% CI: 1.06-3.33). In the multivariate model, there was a statistically significant inverse exposure-response relationship between the self-reported sitting time and severe ED (p for trend=0.029).Conclusions: Self-reported sitting time may be positively associated with ED in Japanese patients with type 2 diabetes mellitus. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the trifecta outcome (continence, potency, and cancer control) longitudinally using robot-assisted laparoscopic radical prostatectomy (RARP)., Method: We prospectively obtained 1-year longitudinal Expanded Prostate Cancer Index Composite (EPIC) data (preoperative and at 3, 6, 9, and 12 months after RARP) from 291 patients who underwent RARP by a single surgeon. Continence was defined as the use of 'zero or one pads'. Potency was defined as the ability to achieve and maintain satisfactory erections firm enough for sexual activity or sexual intercourse. Continence and potency were subjectively determined from patient-reported outcomes (EPIC question nos. 5 and 18). The biochemical recurrence (BCR) rate was defined as two consecutive PSA levels of > 0.2 ng/mL after RARP. Outcomes of the pentafecta were complications and positive surgical margins combined with the trifecta outcomes., Results: Trifecta was achieved in 4.6, 5.6, 8.1, and 9.6% of all patients at 3, 6, 9, and 12 months, respectively. Pentafecta rates were 2.3, 3.0, 5.1, and 6.1%, respectively. Trifecta rates in the nerve-sparing (NS) group were 12.5, 12.7, 18.9, and 23.6%, respectively. The BCR-free rates maintained a high level and were 94.4, 93.9, 93.9, and 90.9%, respectively. Continence rates were improved to 55.2, 75.5, 81.6, and 85.0%, while the potency rate was extremely low at 7.5, 7.8, 9.8, and 10.9%. Even in the NS group, potency rates remained low at 18.1, 18.6, 21.9, and 26.1%, respectively., Conclusion: This longitudinal analysis of trifecta outcomes may be beneficial and should be used when counseling patients with clinically localized PCa., (© 2020. Springer-Verlag GmbH Germany, part of Springer Nature.)

Surgical practices for treatment of rectal cancer in japan have changed from extended dissection along perivascular or parietal plane to pelvic autonomic nerve preserving procedures without compromising radicality of surgical resection. Previous surgical results suggested the significant advantages of extended surgery in survival and local recurrence rate of Dukes B and C patients. More than 15 percent of patients with cancer in the lower rectum have extramesorectal spread to lateral pelvic nodes that can be removed by lateral dissection for local control and cure. Initially the total nerve-preserving procedure has been introduced for a complete preservation of para-aortic and intrapelvic nervous system in patients with early-stage cancer not requiring para-aortic and lateral lymph-node dissection. However, the concept of aggressive surgery for advanced rectal cancer has led to various types of pelvic autonomic nerve-preserving procedures, in which extended lymph-node dissection plus nerve-preserving technique with resection of one or more autonomic nervous segments has been performed. During two decades, total pelvic autonomic nerve-preserving procedure with lateral lymph-node dissection has been used increasingly for Dukes C lesion without increased local recurrence. The overall status of pelvic autonomic nerve-preserving procedures according to clinical experiences in Japan is reviewed in the context of cadaveric anatomic findings, Japanese vs. Western techniques and concepts, and our own clinical data. [ABSTRACT FROM AUTHOR]

Objective: Hypogonadism is a major complication in testicular cancer survivors, but its prevalence varies among studies. In Japan, free testosterone has been used for diagnosis of late-onset hypogonadism syndrome. In the present study, we evaluated the hormone level of testicular cancer survivors and its impact on their quality of life., Methods: Overall, 50 testicular cancer survivors treated from 1990 to 2013 were enrolled. The median age was 44 years. The serum levels of free testosterone, total testosterone and luteinizing hormone were measured. All patients completed the Aging Males' Symptom scale and International Index of Erectile Function-15. The hormone levels of 337 healthy volunteers were used as the control., Results: A total of 32 (64%) patients showed free testosterone levels <8.5 pg/mL. In contrast, just 26% of 50 patients showed total testosterone levels <3.5 ng/mL. Testicular cancer survivors had significantly lower free testosterone and higher luteinizing hormone compared with healthy controls. In contrast, there was no difference in total testosterone between patients and controls. The prevalence of late-onset hypogonadism symptoms of any grade (Aging Males' Symptom total score ≥27) was 60%. Overall, 64% were defined as having moderate erectile dysfunction (International Index of Erectile Function-Erectile Function domain score <17). However, Aging Males' Symptom, International Index of Erectile Function-15 and Erectile Function domain scores did not differ by free testosterone or total testosterone level., Conclusions: This is the first report on the prevalence of hypogonadism determined by free testosterone level in Japanese testicular cancer survivors. Because Aging Males' Symptom and International Index of Erectile Function-15 scores do not necessarily reflect the hormone level, measuring free testosterone is also important in the follow up of these patients., (© 2018 The Japanese Urological Association.)

(Purpose) We conducted cross-sectional studies two times, in 1992 and 2007 and investigated the longitudinal changes of fT levels and sexual function by comparing the results. (Methods) In 1992 and 2007, we conducted cross-sectional surveys about lower urinary tract symptoms and sexual function in male inhabitants aged 40 to 79 years in Shimakaki village, Hokkaido. Comparing the results of these surveys, we analyzed longitudinal changes in fT levels and sexual function. FT levels were measured by radioimmunoassay and sexual function was evaluated using a validated questionnaire. (Results) A total of 123 inhabitants participated in the both surveys. The average age at the initial survey was 57.2 years.Complications causing sexual dysfunction were observed in 43 participants (35%) and 75 participants (61%) in the first and second surveys, respectively. Average fT levels were 12.9 pg/ml and 4.4 pg/ml in the first and second surveys, respectively. Linear approximations of fT (Y) using age (X) were Y = -0.12 X+19.6 and Y = -0.10 X+11.6, for the first and second surveys, respectively. Although decreased fT levels with aging were comparable in both surveys, fT levels were lower in the second survey than in the first survey. There was no significant association between fT levels and sexual function. (Conclusions) The fT levels at the time of the second surey were lower than those in the first survey. The fT level has no significant association with sexual function.

Introduction: Vaginal laxity is a highly prevalent and undertreated medical condition., Aim: To evaluate the efficacy and safety of surface-cooled, monopolar radiofrequency (RFc) therapy for the treatment of vaginal laxity in the VIVEVE I trial., Methods: The VIVEVE I trial was a prospective, randomized, single-blinded, and sham-controlled study. Nine study centers in Canada, Italy, Spain, and Japan participated. Women presenting with vaginal laxity were screened and informed consent was obtained. Major study inclusion criteria were premenopausal status, age at least 18 years, at least one full-term vaginal delivery, and normal genito-pelvic examination results. Enrolled subjects were randomized (2:1) to receive RFc therapy (Active [90 J/cm 2 ] vs Sham [1 J/cm 2 ], respectively) delivered to the vaginal tissue., Main Outcome Measures: The primary efficacy outcome was the proportion of randomized subjects reporting "no vaginal laxity" (Active vs Sham) at 6 months postintervention, which was assessed using the Vaginal Laxity Questionnaire. Treatment-emergent adverse events were evaluated in all treated subjects. Secondary efficacy end points included change on the Female Sexual Function Index (FSFI) and the revised Female Sexual Distress Scale (FSDS-R)., Results: No vaginal laxity was achieved by 43.5% and 19.6% (P = .002) in the Active and Sham groups, respectively. Differences in FSFI and FSDS-R total scores (Active vs Sham) were 1.8 (P = .031) and -2.42 (P = .056), respectively, in favor of Active treatment. Treatment-emergent adverse events were reported by 11.1% and 12.3% of subjects in the Active and Sham arms, respectively., Conclusion: The VIVEVE I trial is the first randomized, controlled, blinded, clinical study of RFc for the treatment of vaginal laxity. A single treatment of RFc therapy was found to be safe and associated with both improved vaginal laxity and improved sexual function. The results from this trial support the use of a novel non-surgical therapy for vaginal laxity, a prevalent and undertreated condition., (Copyright © 2016 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)