Acceptance of and Discontinuation Rate from Erectile Dysfunction Oral Treatment in Patients following Bilateral Nerve-Sparing Radical Prostatectomy

Salonia, Andrea; Gallina, Andrea; Zanni, Giuseppe; Briganti, Alberto; Dehò, Federico; Saccà, Antonino; Suardi, Nazareno; Barbieri, Luigi; Guazzoni, G.; Rigatti, Patrìzio; Montorsi, Francesco

doi:10.1016/j.eururo.2007.08.016

Cited by 89 publications

(66 citation statements)

References 23 publications

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“…4 In a similar study, Salonia and colleagues revealed that 50% of patients post-bilateral nerve-sparing surgery freely decided not to start therapy; of those who commenced therapy, 73% eventually discontinued it. 19 The high dropout rates for ED treatment demonstrate that it is vital for urologists to educate patients on treatment options, their correct use and warning of possible side effects.…”

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confidence: 99%

Pursuit of sexual function post-radical prostatectomy

Smyth¹,

Cullen²,

Quinlan³

2012

CUAJ

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Introduction: In the event of the implementation of prostate cancer screening, younger men will be diagnosed more frequently. Erectile dysfunction (ED) is a frequent long-term complication in men post-radical prostatectomy (RP). Since the introduction of RP, urologists have strived to improve postoperative sexual function. There is little literature, however, in the area of ED prescribing and sexual pursuit in men post-RP. We assessed the pursuit of sexual function in this group of patients. Methods: The study involved a detailed questionnaire sent to patients who have undergone radical retropublic prostatectomy (RRP) by one surgeon in one institution to ascertain the impact of ED on lifestyle and ED therapy prescription use. Results: There was a response rate of 59%; most patients who responded were in the 61 to 70 year age group at the time of the survey. About 25% of patients had intercourse more than once in the 4 weeks prior to the survey. A total 50% of patients had no problem or a very small problem with their sexual function. Overall 80% of patients were prescribed ED therapy, but less than 35% of them used it. Conclusion: Sexual frequency peaked in younger patients who were 3 years or more from surgery. Of note, 46% of men either declined the offer of ED therapy or got the prescription and never used it. Only 34% of men had used their ED prescription in the last 4 weeks. Urologists frequently find that patients behave differently postoperatively, with less interest in sexual activity. Interestingly, we found that 50% of our patients classified their sexual function, as at most a small problem. IntroductionProstate cancer is the most common non-cutaneous malignancy affecting men. Its incidence is set to increase by 275% in Ireland over the next 10 years.1 There has been an increase in the number of young men diagnosed with clinically localized disease. As quality of life is more important and rates of distress from erectile dysfunction (ED) are higher in this age group, there is much controversy about ED postradical prostatectomy (RP). RP is the gold standard for organ-confined disease. Unfortunately, there are significant long-term complications as a result of RP, such as urinary incontinence and ED. Landmark work by Walsh and colleagues in the 1980s led to the development of the nerve-sparing RRP.2 These authors reported potency rates of 86% after bilateral nervesparing prostatectomy. 3 The rates of ED post-RP vary greatly in the literature, from 40% to 75%. 4 The introduction of new technologies (laparoscopic and robotic) has led to improved incontinence rates, however ED remains a significant longterm side effect of treatment. Potency rates at 12 months vary for laparoscopic RP from 48% to 72%, 5,6 and from 58% to 80% for robotic. 7,8 We reviewed men who have undergone RRP in our department to assess their level of erectile function and pursuit of sexual function. Although there is plenty of literature on ED post-RRP, there is little investigation into the pursuit of improved sexual function,...

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confidence: 99%

Pursuit of sexual function post-radical prostatectomy

Smyth¹,

Cullen²,

Quinlan³

2012

CUAJ

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“…Similarly to a previous investigation of the use of an oral ED medication in patients who underwent nerve-sparing RP, drug cost was never stated as the reason for dropout in the present study [ 7 ] . This fact is signifi cant because the regional offi ce of the Italian national health service in the Marches region does not refund the cost of ED drugs to patients who have undergone RP, unlike other regional offi ces.…”

Section: Discussionmentioning

confidence: 70%

“…However, such drugs also have disadvantages and limitations that result in considerable dropout rates. In addition, ∼ 50% of patients refuse to undergo postoperative rehabilitation [ 6,7 ] .…”

Section: Introductionmentioning

confidence: 99%

Erectile rehabilitation with intracavernous alprostadil after radical prostatectomy: refusal and dropout rates

et al. 2012

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What ' s known on the subject? and What does the study add? Erectile dysfunction (ED) is a well known implication of radical prostatectomy (RP). Despite the search for technical improvement in the surgical procedure (e.g. nervesparing surgery, robot-assisted RP), many patients still suffer from an inability to achieve a satisfactory erection after surgery. In the last 20 years a great effort has been made to re-establish good sexual function in these patients. Many different approaches have been used, such as intracavernous prostaglandin E1 (PGE1), phosphodiesterase-5 inhibitors, vacuum devices and penile prostheses.Although many studies have addressed the main questions about effi cacy of different approaches to ED, there is a lack of data about adherence to therapy and the main reasons why patients drop out of these treatment programmes. In the present study, a cohort of men treated with RP underwent a postoperative rehabilitation protocol with PGE1 intracavernous injections. During the follow-up period, we were able to assess a real-life practice pattern of adherence and dropout, evaluating the main causes of therapy discontinuation. This could be of help in the counselling of these patients during the path towards erection recovery. OBJECTIVES• To assess the rate of compliance in the fi rst 6 months of a rehabilitation protocol that includes intracavernous alprostadil administration in patients undergoing radical retropubic prostatectomy.• To determine the reasons for and timings of dropout from the protocol by the patients and their subsequent outcomes. PATIENTS AND METHODS• All patients undergoing radical prostatectomy (RP) at our institution between 1 January 2007 and 31 December 2009 were considered for a protocol of postoperative intracavernous sexual rehabilitation and were administered entry questionnaires to evaluate their preoperative sexual activity.• Four weeks after surgery, the patients were invited to return for a fi rst visit, where the aim of the protocol and possible risks and benefi ts were explained. For those who agreed to attend, subsequent visits to include assisted self-administration of increasing doses of intracavernous alprostadil and a period of autonomous homely self-administration were planned.• Patients were followed up at 3-month intervals, where data on functional outcomes, patient satisfaction, and the number of patients who dropped out and their reasons, were recorded by means of appropriate questionnaires.• Statistical analysis was performed using Student ' s t -test or a chi-squared test, where appropriate. RESULTS• Of 430 patients, 157 (36.5%) refused to undergo the protocol of rehabilitation and 18.6% of the patients who began the protocol dropped out over the fi rst 6 months.• Reasons for refusal were: patient ' s lack of sexual interest (51.6%); lack of interest by the partner (30.2%); and presence of transitory incontinence (26.7%).• Reasons for dropout were: disappointment with treatment effi cacy (64.7%); injection pain (45%); and diffi culties with or fear of perfo...

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“…In the absence of formal counselling and discussion, men with good preoperative erectile function and strong desire to maintain it will often not pursue postoperative therapy and, even if they do, often discontinue therapy after a short period of time. 3 These findings are not surprising, given the many issues facing men after prostatectomy and the discouragingly long time before spontaneous recovery of erectile function. Unfortunately, by the time many men seek care for sexual issues after prostatectomy, significant and irreversible tissue damage has occurred.…”

Section: Penile Rehabilitation After Radical Prostatectomymentioning

confidence: 93%

Penile rehabilitation after radical prostatectomy

Kacker

O’Leary

2013

Trends Urol & Men's Health

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Erectile dysfunction remains a common complication after radical prostatectomy. Natural recovery of erectogenic stimulus may take years after nerve‐sparing surgery, during which time the penis undergoes physiological and structural changes that are harmful to erectile function. The goals of penile rehabilitation are to prevent these changes and thereby produce a faster and better return of erections and sexual function. In this article, the authors discuss current approaches to penile rehabilitation after prostatectomy. Copyright © 2013 John Wiley & Sons

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Acceptance of and Discontinuation Rate from Erectile Dysfunction Oral Treatment in Patients following Bilateral Nerve-Sparing Radical Prostatectomy

Cited by 89 publications

References 23 publications

Pursuit of sexual function post-radical prostatectomy

Pursuit of sexual function post-radical prostatectomy

Erectile rehabilitation with intracavernous alprostadil after radical prostatectomy: refusal and dropout rates

Penile rehabilitation after radical prostatectomy

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