SX21

Bladder cancer

Content written by John P. Mulhall, MD

There are several types of cancer of the bladder, all of which when diagnosed are distressing for a patient. The distress associated with the diagnosis of cancer can lead to withdrawal from sexual activity, loss of libido, and in men, erectile problems. The detailed management of bladder cancer is beyond the scope of this section but revolves around either chemotherapy (systemic or intravesical, that is, into the bladder), or surgery. Intravesical chemotherapy is associated with certain side effects, specifically irritation on the bladder, which, as you can imagine may at least temporarily interfere with a man’s interest in having sexual relations. Systemic chemotherapy in the short term is associated with a sense of ill feeling and in the long term may affect a man’s ability to produce testosterone. The latter hormone is a critical metabolic hormone required for many metabolic activities, one of which is libido. Superficial bladder cancer can be managed with relatively minor surgical procedures performed through the penis known as transurethral resection of bladder tumor (TURBT). These procedures generally have no negative impact upon a man’s erectile function. However, muscle invasive bladder cancer is generally treated with a cystoprostatectomy. This operation removes the bladder, the prostate and its adjoining organs and is associated frequently with, at least temporary and often permanent problems with erection (see section on radical prostatectomy).

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