Optimal strategy for penile rehabilitation after robot-assisted radical prostatectomy based on preoperative erectile function
ABSTRACT Objective To define the optimal penile rehabilitation programme (PRP) based on preoperative Sexual Health Inventory for Men (SHIM) scores after robot-assisted radical prostatectomy (RARP). Patients and Methods The medical records of 203 patients who underwent bilateral nerve-sparing RARP between 2007 and 2011 were reviewed for the present retrospective study. According to patients' preoperative erection status, group 1 (SHIM = 8-16), group 2 (SHIM = 17-21) and group 3 (SHIM = 22-25) were defined. After bilateral nerve-sparing RARP, phosphodiesterase-5 inhibitors (PDE5Is), a vacuum erection device (VED), the combination of PDE5Is and a VED, or none of them were utilized by all patients for penile rehabilitation. Treatment success was defined as a rigid erection suitable for successful sexual intercourse. Results The numbers of patients in groups 1, 2 and 3, respectively, were 9, 22 and 73, and the mean erectile function recovery periods (EFRPs) were 15.44 +/- 7.73, 12.31 +/- 8.12 and 8.73 +/- 5.67 months (P < 0.05). Group 3 offered the best results for EFRP. Only PDE5Is or the combination of PDE5Is and VED use had a beneficial effect on EFRP (P < 0.05). Using PDE5Is and VED together provided the best result, but there was no difference between PDE5Is and a VED (P > 0.05). Conclusions After bilateral nerve-sparing RARP, PRP with PDE5Is, including the combination of PDE5Is and VED, has a beneficial effect on erectile function recovery across all levels of baseline erectile function. Further large randomized control studies are needed to validate these findings.
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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
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ABSTRACT: To identify the health-related quality of life (HRQoL) domains that radical prostatectomy (RP) impacts most negatively and to define the recovery of these domains over 30 months of observation. A total of 1,200 RP patients completed the Patient-Oriented Prostate Utility Scale-Psychometric (PORPUS-P; range 0-100, higher is better), a prostate cancer-specific HRQoL measure, prior to RP and at 0-3 (T1), 3-9 (T2), 9-18 (T3) and 18-30 (T4) months post-RP. HRQoL changes were examined using paired t tests and a mixed-effect growth curve model. Multivariable analyses were performed to investigate demographic and treatment factors predicting the change in HRQoL. Mean baseline PORPUS-P score, 83.1, fell to 66.5 (p < 0.001) at T1. Over time HRQoL improved but did not return to baseline (T4 mean 76.4, p < 0.001). Domain analysis revealed that sexual function (p < 0.001), sexual drive (p < 0.001), energy (p = 0.001) and bladder control (p < 0.001) failed to return to baseline at T4. Sexual function demonstrated the greatest impairment overall. The multivariable model revealed Black men experienced greater losses in global HRQoL compared with White men (coefficient -2.77, 95 % CI -5.00 to -0.54, p = 0.015). High baseline HRQoL, pro-erectile aid use and bilateral nerve-sparing were significantly associated with smaller reductions in HRQoL post-RP. Overall HRQoL, sexual drive, sexual function, energy and bladder control do not return to preoperative levels within 30 months post-RP. Black patients experience the greatest reductions in HRQoL. HRQoL losses may be ameliorated by use of pro-erectile aids. These findings help to identify at-risk patient populations and inform survivorship programs.Quality of Life Research 03/2014; 23(8). DOI:10.1007/s11136-014-0664-1 · 2.86 Impact Factor
- Cancer 08/2014; 120(15). DOI:10.1002/cncr.28735 · 4.90 Impact Factor