Sexual rehabilitation with intracavernous alprostadil after radical prostatectomy: Outcomes from a nursing program

Abstract

Introduction and objectives: Erectile dysfunction (ED) is a common complication after radical prostatectomy that affects quality of life. There are several therapeutic options, including intracavernous alprostadil injections (IAI). However, no specific recommendations have been made on the optimal rehabilitation strategy. In this study we evaluated a sexual rehabilitation program (SRP) with IAI for patients with ED after radical prostatectomy, assessing the rate of compliance and reasons for dropout.Methods: The sexual rehabilitation program (SRP) was offered to all patients who underwent radical prostatectomy from 1 January 2010 to 31 December 2019. The first consultations were performed by a urology specialist nurse, explaining the IAI procedure and possible complications. The program was considered successful when the patients achieved autonomy in the drug preparation with a good injection technique. A medical consultation was performed at 6 months evaluating the IAI usage and adverse events. In case of dropout, a questionnaire about reasons for dropout was performed. The primary endpoint was the rate of compliance and dropout of the program. Secondary endpoints were the reasons for dropout and adverse events. Results: 340 patients underwent radical prostatectomy at our institution, and 123 patients accepted to participate in the rehabilitation program. A total of 96 patients (78%) successfully completed the SRP, and at 6 months 60 (62.5%) still used IAI. Concerning the reasons for dropping out, the most frequent were the need of injectable therapy and pain. Regarding complications, 17 patients (13.8%) reported pain related to the injection and 1 patient (0.8%) had a priapism, managed with conservative treatment. Conclusions: Management of post-radical prostatectomy ED by a nursing program achieved good rates of patients’ self-injection accomplishment and treatment compliance. Close monitoring for dose adjustment and management of post-injection penile pain is required during the follow-up.

Bibliometric trends in priapism research publications

“…Keywords are the author's condensed and highly concentrated core ideas and thoughts of the article, and are often used to detect the hot spots and focus of research in a discipline, especially high-frequency keywords as the analysis object. The high-frequency keywords co-occurrence were mainly priapism, management, erectile dysfunction, penile erection, penis, diagnosis, high-flow priapism and impotence, revealed that study concentrated in diagnosis and ED due to priapism [19][20][21]. Keyword cluster timeline map presented the key word time evolution of each cluster, from the initial study focus on "sickle cell disease, complication" to the current research dimension of "low flow priapism, high flow priapism, peyronie disease, mechanism, management" changes [22][23][24].…”

Quality of Life after Radical Prostatectomy: A Longitudinal Study

“…Men who are newly diagnosed with prostate cancer can experience a significant level of anxiety and depression [ 9 ]. After radical prostatectomy, mental health issues are frequently associated with urinary and sexual symptoms, namely urinary incontinence, erectile dysfunction, and sexual impotence, resulting in symptoms of depression and reduced quality of life one year after surgery [ 10 , 11 , 12 ].…”