Re: Indwelling Ureteral Stents and Sexual Health: A Prospective, Multivariate Analysis. M. C. Sighinolfi, S. Micali, S. De Stefani, A. Mofferdin, M. Grande, M. Giacometti, N. Ferrari, M. Rivalta and G. Bianchi J Urol 2007; 178: 229-231

Reply by Authors During the last few decades progress in endourology has led to a widespread application of such techniques, and procedures such as ureteral stenting and nephrostomic drainage have become routinely adopted. As a result, the number of patients dealing with these devices has rapidly increased, thus focusing attention on the related quality of life. Consistent with this statement, Joshi et al developed the Ureteral Stent Symptom Questionnaire in 2003,1 which represents a validated instrument to assess stent related bother, concerns and impact on global quality of life. [5] and [7] The USSQ actually addresses in a proper and detailed approach the whole of urinary symptoms, as well as the consequent bother that so frequently affects these patients. Domains regarding pain and stent related therapies (antibiotics, painkillers) are accurately designed. Furthermore, work, occupation, social activities and relationships are considered with regard to ureteral stent permanence. Sexuality is assessed in the questionnaire by 4 questions, investigating the presence vs absence of sexual activity, and then dealing with pain and sexual satisfaction. As a result, all crucial points of stent related sexuality are analyzed according to the questionnaire. However, the aim of our study was to perform a detailed analysis of all the domains connected to sexuality in both genders with particular attention to erectile function, which has been so widely addressed in the last decade.8 Moreover, since female sexuality represents a complexity of events, we attempted to investigate all steps of the process to emphasize the critical points. In this setting the use of the International Index of Erectile Function-5 and the Female Sexual Function Index seems to be an adequate choice, matching our aims more properly. Furthermore, an additional end point of the study was to investigate thoroughly the sequential changes that occur in sexual health before and after stent insertion, and this goal can be achieved only with specific questionnaires administered to the patient before the procedure. Since the recent literature focuses on the relationship between erectile dysfunction and lower urinary tract symptoms,9 we analyzed the correlation between urinary complaints and sexual dysfunction. Although this outcome can be assessed even with the USSQ, the use of specific questionnaires considering different sorts of symptoms is highly recommended to perform a critical and statistical analysis. Behind this consideration, our outcomes are consistent with those previously reported in other studies. Ureteral stenting is a simple and safe procedure for the urologist but has significant consequences on the routine life of the patient in all of its main areas. The USSQ is a consistent and reliable instrument to analyze those concerns, and physicians have to consider this tool in urological practice. References 1H.B. Joshi, N. Newns, A. Stainthorpe, R.P. MacDonagh, F.X. Keeley Jr, A.G. Timoney Ureteral Stent Symptom Questionnaire: development and validation of a multidimensional quality of life measure