Predicting participation in and successful outcome of a penile rehabilitation programme using a phosphodiesterase type 5 inhibitor with a vacuum erection device after radical prostatectomy

Division of Urologic Surgery, Department of Surgery and Duke Prostate Center Department of Radiation Oncology and Duke Prostate Center, Duke University Medical Center, Durham, NC, USA.
BJU International (Impact Factor: 3.13). 04/2012; 110(11C). DOI: 10.1111/j.1464-410X.2012.11168.x
Source: PubMed

ABSTRACT Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? The role of the vacuum erection device (VED) has increased with its use in combined therapy with a phosphodiesterase type 5 inhibitor (PDE5i) for penile rehabilitation after radical prostatectomy (RP) and radiotherapy. The advantages of the VED are non-invasive, cost-effective, and a possibility of preventing shrinkage of penis length. Albeit current widespread use of penile rehabilitation programmes for post-RP erectile dysfunction, independent predictors for the rehabilitation participants, as well as for its treatment success have not been fully investigated. In the present study, we have added several new predictors for rehabilitation participation, e.g. African-Americans and higher preoperative sexual function. Conversely, higher preoperative PSA concentrations and the presence of positive surgical margins were predictors for avoidance of rehabilitation. Notably, there was a primary surgeon difference, which had a trend for predicting outcome of the rehabilitation among the participants, implying their surgical technique and follow-up might influence success of the rehabilitation. OBJECTIVES: •  To investigate baseline demographic and clinicopathological characteristics of men who participate in our penile rehabilitation programme after radical prostatectomy (RP). •  To determine predictors for participation in rehabilitation, as well as successful rehabilitation outcome using multivariable logistic regression analyses. PATIENTS AND METHODS: •  We analysed data on 2345 consecutive patients who underwent RP between 2001 and 2009 in our institution. •  The decision to participate in penile rehabilitation using phosphodiesterase type 5 inhibitor (PDE5i) with a vacuum erection device (VED) was based on the patient's choice after post-RP discussions. •  Rehabilitation success was defined using the following criteria: (i) patients who continued the penile rehabilitation programme and did not switch treatment from PDE5i to other erectile aids, (ii) success was noted in men who had an Expanded Prostate Cancer Index Composite (EPIC) sexual function (SF) score of >75% of the patient's baseline EPIC score, and (iii) patients who answered that they achieved adequate erections with a PDE5i. •  Logistic regression analysis was used to identify factors associated with treatment participation and its success. RESULTS: •  Of 676 patients, 354 (53.2%) men participated in a penile rehabilitation programme. Among 329 rehabilitation participants with available data, 96 (29.2%) had treatment success. •  In multivariable regression analysis, African-Americans (odds ratio [OR] 3.47, P < 0.001), and higher preoperative SF (OR 1.02, P < 0.001) were associated with participation in rehabilitation. •  Higher preoperative PSA concentration (OR 0.50, P= 0.004) and presence of positive surgical margins (OR 0.68, P= 0.042) were found to be independent predictors for non-participation in the rehabilitation. •  For rehabilitation outcomes, being older at surgery (OR 0.93, P= 0.001) and adjuvant therapy (OR 0.34, P= 0.047) had a negative association with successful outcome. •  There was a trend in the relationship between primary surgeon and rehabilitation success (OR 1.05, P= 0.053) CONCLUSIONS: •  Those patients who have risk factors, e.g. adverse prostate cancer features, need to be carefully counselled and encouraged to participate in the penile rehabilitation programme. •  Clinicians could lead patients toward successful outcomes if appropriate surgical techniques and rehabilitation are provided.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To develop a management strategy (rehabilitation programme) for postsurgical erectile dysfunction (ED) among men experiencing ED associated with treatment of prostate, bladder or rectal cancer that is suitable for use in a UK NHS healthcare context. PubMed literature searches of ED management together with a survey of 13 experts in the management of ED from across the UK were conducted. Data from 37 articles and completed questionnaires were collated. The results discussed in this study demonstrate improved objective and subjective clinical outcomes for physical parameters, sexual satisfaction, and rates of both spontaneous erections and those associated with ED treatment strategies. Based on the literature and survey analysis, recommendations are proposed for the standardisation of management strategies employed for postsurgical ED.
    International Journal of Clinical Practice 11/2013; 68(5). DOI:10.1111/ijcp.12338 · 2.54 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Many therapies for erectile dysfunction (ED) after prostate cancer treatment improve erectile firmness, yet, most couples stop using aids within 1-2 years. Patients and partners who expect immediate and complete success with their first ED treatment can be demoralized when they experience treatment failure, which contributes to reticence to explore other ED aids. Comprehensive patient education should improve sustainability and satisfaction with ED treatments. Pre-emptive and realistic information should be provided to couples about the probability of recovering natural erections. Beginning intervention early and using a couple-based approach is ideal. Recommendations are provided about the timing of ED treatment, the order of aid introduction, and combination therapies. Renegotiation of sexual activity is an essential part of sexual adaptation. From the outset of therapy, couples should be encouraged to broaden their sexual repertoire, incorporate erection-independent sexual activities, and continue to be sexual despite ED and reduced libido.
    Nature Reviews Urology 03/2015; 12(3):167-176. DOI:10.1038/nrurol.2015.29 · 4.52 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: IntroductionDespite the high prevalence of erectile dysfunction (ED) in men with prostate cancer, little is known about the use of ED drugs. Also, the possible influence of socioeconomic factors on ED drug use has not been studied previously.AimThe aim of this study was to examine determinants and patterns of ED drug use before and after diagnosis in men with localized prostate cancer.Methods Using a nationwide population-based cohort, 25,390 men with localized prostate cancer diagnosed between 2006 and 2009 and 126,944 control men were identified and followed for filled ED drug prescriptions over a 3-year period, ranging from 1 year before and up to 2 years after diagnosis.Main Outcome MeasuresThe main outcome measure was the proportion of men with at least one filled ED drug prescription after diagnosis.ResultsThe number of men using ED drugs increased markedly following diagnosis. Men who underwent radical prostatectomy had the strongest increase, with a cumulative proportion of 74% for at least one filled prescription within the first 2 years after diagnosis. The corresponding proportion was 33% in men treated with radiotherapy, 21% in men on active surveillance, 10% in men on watchful waiting, and 8% in control men. Among men who underwent prostatectomy, usage attenuated over time. Determinants of postdiagnostic use were young age at diagnosis, high income, high education, and a low- or intermediate-risk cancer.Conclusion Although drugs for ED are commonly prescribed after diagnosis, use among most men is transient and influenced by socioeconomic status. Posttreatment counseling and affordable ED drugs are likely to reduce treatment dropout and disparities in use and help improve sexual health and quality of life in men with prostate cancer. Plym A, Folkvaljon Y, Garmo H, Holmberg L, Johansson E, Fransson P, Stattin P, and Lambe M. Drug prescription for erectile dysfunction before and after diagnosis of localized prostate cancer. J Sex Med **;**:**–**.
    Journal of Sexual Medicine 06/2014; 11(8). DOI:10.1111/jsm.12586 · 3.15 Impact Factor