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: 3.53). 04/2012; 110(11C). DOI: 10.1111/j.1464-410X.2012.11168.x
Source: PubMed


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.

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    ABSTRACT: Changes in sexual bother (SB) following radical prostatectomy (RP) negatively affect health-related quality of life (HRQoL) of prostate cancer survivors. However, post-operative SB tends to be neglected whereas sexual function (SF) is thoroughly assessed in clinical practice and few studies have focused on and evaluated patients' SB. We retrospectively reviewed 2 345 consecutive patients who underwent RP between 2001 and 2009 at a single institution. SF and SB were assessed using Expanded Prostate Cancer Index Composite (EPIC) questionnaires. We stratified our cohort by SB recovery and post-operative SF status, including a subset of men who recovered SB despite persistent post-RP sexual dysfunction. Multivariable logistic regression analyses were conducted to identify factors for men who have SB recovery. Of 319 eligible patients, 133 (41.7%) recovered their SB at a mean of 20 months after RP. Among the 133 men who demonstrated SB recovery, 109 had post-operative sexual dysfunction. Patients with SB recovery despite post-RP sexual dysfunction were more likely to be old (p = 0.004), to have higher clinical T stage (p < 0.001), to have more non-nerve-sparing RP (p < 0.001), to have lower pre-operative EPIC-SF/SB scores (p < 0.001), to have more extracapsular extension (p = 0.031) and to be PDE5i non-users after surgery (p < 0.001). In multivariable analysis, predictors for this subset were lower comorbidity (OR 0.62, p = 0.043), higher clinical cancer stage (OR 2.35, p = 0.026), worse pre-operative SF (OR 0.98, p = 0.010), SB (OR 0.98, p < 0.010) and no PDE5i use (OR 0.37, p = 0.002); age was not related (OR 0.99, p = 0.555). As SB can influence patients' overall HRQoL, expectations of SB recovery should be provided to patients in the same way that SF recovery is presented. This study may help clinicians to discuss SB with patients and assess their potential for SB recovery following RP.
    Full-text · Article · Mar 2013 · Andrology
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    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.
    Full-text · Article · Nov 2013 · International Journal of Clinical Practice
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    ABSTRACT: Trotz verschiedener Publikationen zur Rehabilitation der erektilen Funktion (EF) nach nervenerhaltender radikaler Prostatektomie (nsRP) scheint derzeit kein einheitlicher Therapiestandard zu existieren. Ziel dieser Untersuchung war, ob und nach welchen unterschiedlichen Konzepten die Rehabilitation der EF unterstützt wird.Wir führten eine deutschlandweite Befragung von Urologen (Praxis/Klinik/Belegarzt/Rehabilitationseinrichtung) im Zeitraum von 10/2010 bis 05/2012 mittels Fragebogen durch. Es wurde abgefragt, ob und welche Konzepte zur Rehabilitation der EF nach nsRP durchgeführt werden. Neben den verschiedenen Therapieoptionen wurden auch die Häufigkeit, die Therapiedauer und der Zeitpunkt des Therapiebeginns eruiert.Es konnten 188 Fragebögen vollständig ausgewertet werden. Die Verteilung ergab: Klinik n = 79, Praxis n = 106, davon 24 % Belegärztlich tätig, Reha n = 3. In der Frage nach dem Therapiekonzept existierten insgesamt 39 unterschiedliche Regime. Am häufigsten kommt die Unterstützung der Rehabilitation mittels PDE-5-Inhibitoren zur Anwendung (88 %). Davon in 45 % als Bedarfsmedikation und in 55 % täglich oder regelmäßig mehrfach pro Woche. Schwellkörperautoinjektionstherapie (SKAT), MUSE (,,medicated urethral system for erection“) und die Vakuumpumpe werden in 32, 6 und 30 % eingesetzt. 14 % der Befragten führen keine ,,aktive“ Rehabilitation durch.Es kommen derzeit viele unterschiedliche Therapiekonzepte zur Unterstützung der Rehabilitation der EF nach nsRP zur Anwendung. Am häufigsten werden die PDE-5-Inhibitoren eingesetzt. Trotz verschiedener Studien zur Effektivität ist die Frage nach dem ,,optimalen Konzept“ noch ungeklärt.
    No preview · Article · Dec 2013 · Der Urologe
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