Sexual rehabilitation across the cystectomy care pathway: pragmatic guidance for multidisciplinary teams; a narrative review.

BACKGROUND

Radical cystectomy with urinary diversion can substantially affect sexual function, body image, and intimate relationships. Structured sexual rehabilitation guidance that is specific to cystectomy and usable within nursing and rehabilitation pathways remains limited, especially for women and for patients living with urinary diversion.

OBJECTIVE

To develop a practice-oriented, evidence-informed and consensus-based framework for sexual rehabilitation across the cystectomy care pathway.

METHODS

We conducted a targeted narrative review of literature published between January 2000 and June 2025 in the Medical Literature Analysis and Retrieval System Online via PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library, supplemented by cancer survivorship, ostomy, pelvic rehabilitation and sexual medicine guidance. Two reviewers screened records and mapped evidence by recovery phase, sex-related anatomy, diversion type, presenting problem and delivery setting. Recommendations were refined through two rounds of multidisciplinary author-panel consensus. The work was aligned with the Scale for the Assessment of Narrative Review Articles, intervention reporting principles from the Template for Intervention Description and Replication checklist, selected Appraisal of Guidelines for Research and Evaluation principles, and sex- and gender-sensitive reporting guidance.

RESULTS

The revised framework is organised into prehabilitation, early postoperative care and late rehabilitation. It distinguishes nurse-led, shared interdisciplinary and specialist-only actions; specifies transition criteria between phases; integrates diversion-specific intimacy planning; and provides safety precautions for pelvic floor, manual therapy, pharmacological and psychosexual interventions. Outcome monitoring uses the International Index of Erectile Function, 5-item version; the Female Sexual Function Index, 19-item version; and the Body Image Scale, supplemented by goal-based and process indicators.

CONCLUSIONS

The framework offers a cautious, adaptable route for integrating sexual health assessment, education, pelvic rehabilitation, stoma-related support, psychosexual communication and referral into routine cystectomy survivorship care. It should be implemented with local scope-of-practice governance and evaluated prospectively, including patient-partner co-design and long-term outcomes beyond 12 months.