Is it Worth Starting Sexual Rehabilitation Before Radical Prostatectomy? Results From a Systematic Review of the Literature

Abstract

Background and Purpose: Sexual dysfunction (SD) is a frequent side effect associated with radical prostatectomy (RP) for prostate cancer (PCa). Some studies have showed the benefit associated with preoperative sexual rehabilitation (prehabilitation) and Enhanced Recovery After Surgery (ERAS) for RP, but no clear clinical recommendations are available yet. Our aim was to conduct a systematic review on sexual prehabilitation prior to RP for patients with a localized PCa and analyze the impact on postoperative sexual health compared with the standard post-operative care.Methods: We performed a systematic review of the literature following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) recommendations.Results: Four randomized control trials and one retrospective comparative study were included in the analyses. Three of the five studies showed an improved EF recovery post-RP in the prehabilitation group compared to the standard of care represented by: higher International Index of Erectile Function 5 score (IIEF5) or IIEF score (p < 0.0001) and a higher percentage of patients reporting return of EF based on the Sexual Encounter Profile (SEP) (56 vs. 24%, p = 0.007). Self-confidence, therapeutic alliance, and adherence to treatment were stronger for patients with preoperative consultations (p < 0.05) and EF recovery was better in cases of a higher number of follow-up visits (OR 4–5 visits vs. 1:12.19, p = 0.002).Discussion: Despite heterogenous methods and high risks of bias in this systematic review, starting sexual rehabilitation prior to surgery seems to ensure better EF recovery. This prehabilitation should include information of both the patient and his or her partner, with a closer follow up and the use of a multimodal treatment approach that still remains to be defined and validated (oral medication, vacuum devices, pelvic floor muscle training, etc.).

Efficacy of Tadalafil in Penile Rehabilitation Started Before Nerve-Sparing Robot-Assisted Radical Prostatectomy: A Double-Blind Pilot Study

“… 12 , 34 In a systematic review of the literature concerning oral medication, vacuum erection devices, and counseling, the prehabilitation group showed higher rate of EF recovery than the control group (56% vs 24%; P = .007). 11 Starting penile rehabilitation prior to surgery may result in better postoperative recovery of EF than postoperative rehabilitation. Furthermore, currently, the administration of PDE5-Is is the most effective treatment in penile rehabilitation after nsRARP, and regular doses of PDE5-Is have significant efficacy and good tolerability without serious adverse events.…”

“… 7 , 8 , 9 Various protocols of penile rehabilitation using phosphodiesterase type 5 inhibitors (PDE5-Is) have been shown to be effective in promoting early recovery of EF. 10 , 11 , 12 In particular, tadalafil, a long-acting PDE5-I, has been shown to be well tolerated and effective for rehabilitation in patients with ED after nsRARP. 13 , 14 …”

Prostate Cancer Diagnosis, Treatment and Outcomes in Patients with Previous or Synchronous Colorectal Cancer: A Systematic Review of Published Evidence

“…Unfortunately, there are not enough data for guiding the multidisciplinary strategy and there is a clinically unmet need in determining the preferred treatment for synchronous or metachronous PCa/CRC [ 7 ]. Although in the late 1990s, several case reports have been reported describing varying management approaches for the treatment of synchronous CRC and PCa with favorable outcomes, in recent years, the diagnostic and treatment algorithms for these cancers have significantly evolved [ 1 , 2 , 3 , 4 , 8 , 9 , 10 , 11 , 12 ]. The aim of the present systematic review is to summarize available evidence about the diagnosis and treatment of PCa in patients with synchronous CRC or a history of CRC.…”

Patient Education for Radical Prostatectomy: Development of a Program Tailored to the Needs of Prostate Cancer Patients

“…Studies have sought to report the interest of erectile rehabilitation post RP for the most rapid recovery of a functional erection (allowing penetration; Terrier et al, 2014 ; Toussi et al, 2021 ). The sooner those rehabilitation programs start, the most effective the program is on sexual dysfunction ( Schoentgen et al, 2021 ; Tang et al, 2020 ) The objectives of this rehabilitation programs are to limit the installation of intra-cavernous fibrosis, to oxygenate the cavernous bodies, to limit the retraction of the penis and the loss of size. But those rehabilitation programs, even though broadly disseminated, are predominantly based on pharmacology and concentrate on the erection as if it was the only factor for men’s successful sexuality ( Philippou et al, 2018 ).…”

“…All these dimensions must be taken into account if sexual health is to be achieved in these patients ( Chung & Brock, 2013 ; Salonia et al, 2017 ). The actual state-of-the-art recommendations in post RP ED management reports that (a) administration of PDE5 is vaccum erection devices and intracorporeal injections are equally effective treatments; (b) whatever treatment is undertaken, it is better to initiate it as close as possible from surgery ( Bratu et al, 2017 ; Liu et al, 2017 ; Schoentgen et al, 2021 ); (c) in case of refractory ED, penile prosthesis implant is an effective and satisfactory alternative ( Lima et al, 2020 ); and (d) yet no proper algorithm or specific regimen is established as optimal ( Salonia et al, 2017 ). Lately, few trials assessed more comprehensive and multimodal rehabilitation programs, including psychological intervention and sexual counseling ( Matthew et al, 2018 ; Osadchiy et al, 2020 ), but those are scares and yet to be disseminate in the common practice, whereas patients’ needs stay considerable and unsatisfied ( Giuliano et al, 2008 ).…”