Sexual bother following radical prostatectomyjsm.
ABSTRACT The literature on sexual bother in men with prostate cancer is conflicting. While some data indicate high bother from erectile dysfunction (ED) following prostate cancer treatments, other results suggest the life-saving nature of the treatment may mitigate ED concern.
(i) To determine if sexual bother increases post radical prostatectomy (RP); (ii) To determine if men psychologically adjust to diminished erections; (iii) To identify baseline predictors of post-RP sexual bother.
We identified 183 men treated with RP who completed inventories including Erectile Function Domain (EFD) and Sexual Bother (SB) preoperatively and at 12 and 24 months postoperatively. Statistical analyses included repeated-measures analysis of variance and linear multiple regression.
The EFD of the International Index of Erectile Function and the SB subscale from the Prostate-Health Related Quality-of-Life Questionnaire.
The mean age of the sample was 58 +/- 7 years. The mean EFD scores decreased from baseline to the 24-month time point (24.8 vs. 16.7, P < 0.01). The mean SB scores increased from baseline to the 12 month time point (4.3 vs. 6.7, P < 0.01), and remained stable from the 12 month to 24 month time points (6.7 vs. 6.3, P = not significant [ns]). This was true for men with ED (EFD < 24) and without ED. Only 7% of men with ED moved from being "bothered" at 12 months to "no bother" at 24 months. There were no significant baseline predictors of sexual bother; baseline variables tested were: age, race, marital status, prostate-specific antigen (PSA) value, EFD, sexual desire, and intercourse satisfaction. The change in EFD scores was the only significant predictor of SB scores.
Sexual bother increases post-RP, even in men with "good" erections postoperatively, and includes shame, embarrassment, and a reduction in general life happiness. Because men do not seem to "adjust" to ED, referral or evaluation should occur early in this population.
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ABSTRACT: To measure the impact of psychotherapy associated to the use of Tadalafil in the improvement of erectile function after radical prostatectomy. From 132 patients surgically treated for prostate cancer, thirty sequential patients with bilateral nerve sparing, low risk controlled disease and post-surgery erectile dysfunction (ED) took Tadalafil 20mg and underwent psychotherapy sessions, both weekly for three months. Patients were interviewed to establish the quality of erection using the instrument IIEF-5 and to measure psychological features impacting erectile function, aspects related to function, dysfunction, physical and emotional discomfort were evaluated with the help of an intensity scale. The average age was 62.5 (46 to 77 years), 96.7% had a stable relationship, 56.6% of the patients accepted the diagnosis and 43.2% exhibited defense mechanisms (3.3% negation, 6.6% revulsion, 33.3% concern). A positive correlation was observed between erectile function and time exposed to treatment (IIEF-5 - 9.7 to 13.3, p=0.0006), with increased satisfaction with life in general (2.1 to 2.7, P=.028) and sexual life (3.1 to 3.7, P=.028), added to facilitation of expressing feelings/emotions (1.8 to 3.0, P=.0008). Satisfaction with relationship and intimacy with partner did not present significant improve (P=.12 and P=.61, respectively). A holistic patient care with more complete ED rehabilitation includes psychotherapy with a positive correlation between erectile function and treatment exposition. Psychotherapy allowed the identification of important spouse related factors in this scenario.Actas urologicas españolas 12/2013; · 1.15 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). · 2.86 Impact Factor