Does Management of Erectile Dysfunction after Radical Prostatectomy Meet Patients' Expectations? Results of a National Survey (REPAIR) by the French Urological Association

Abstract

Introduction Little stress has been placed on patients' satisfaction with regard to management of erectile dysfunction (ED) after radical prostatectomy (RP) and on how physicians' and patients' views may differ in this respect. Aim To assess the extent to which urologists' perceptions of their patients' expectations and the actual needs expressed by these patients coincide with regard to ED and its management. Methods Those French urologists who provisionally accepted to participate in the survey (760/1,272; 59.7%) received a physician survey instrument, 10 patient data forms to be completed during the first 10 consultations of patients who had undergone RP less than 12 months previously, and 10 copies of a questionnaire for patients to complete. Main Outcome Measures Patient-reported sexual activity, satisfaction with sexual activity (Male Sexual Health Questionnaire), and treatment expectations; urologists' subjective assessment of the importance given by their patients to ED; the timing they propose for starting ED treatment. Results Overall, 535/1,272 urologists (42%) returned the physician survey instrument (45.6 ± 8.7 years, 28–67) and 2,644 patients completed the patient questionnaire (64.0 ± 6.1 years, 44–79). The percentage of patients having intercourse pre RP was highly age-dependent (89% at 55–59 years; 56% at ≥70 years); 70–75% of patients claimed to be satisfied with their pre-RP sexual activity. Post RP, 27–53% of patients (depending upon length of follow-up), who were sexually active pre RP, had intercourse. Only 18% (<5 months' follow-up) or 28% (>5 months' follow-up) were satisfied. Over half (53%)—and especially the younger patients—expected early ED treatment (1 or 3 months post RP). Agreement between patients' expectations and urologists beliefs on timing of ED treatment was poor. At the 1- or 2-month visits, 73% of patients were already finding ED frustrating. Conclusions Erectile dysfunction is an important issue for patients who have undergone RP. Urologists tend to underestimate patients' distress and desire for early treatment.

Vacuum therapy in erectile dysfunction—science and clinical evidence

“…55,[63][64][65] Currently, PR methods include the use of PDE 5 I, intracavernosal self-injection/intraurethral suppositories, VED or a combination of different therapy modalities. 55,[63][64][65] Pathophysiology Erectile function (EF) becomes impaired immediately after RP secondary to cavernous nerve damage during surgery, resulting in neuropraxia. 66 Even with the most meticulous nerve-sparing dissection, some degree of neuropraxia is unavoidable because of the close proximity of the nerves to the prostatic gland.…”

Electronic patient self-assessment and management (SAM): a novel framework for cancer survivorship

“…As a result, the patient cannot get feedback from his family doctor as to whether post-operative problems, such as urinary symptoms, are typical or constitute a complication in need of intervention. Similarly, the patient may not be offered appropriate advice on urinary and sexual rehabilitation[16,17], or tests for recurrence.…”

Sexual Dysfunction After Radical Prostatectomy: Treatment Failure or Treatment Delay?

“…All subjects believed that surgery would not affect their sexual function. Erectile dysfunction is the most common long-term side effect of prostate cancer treatment, significantly affecting men's perceptions about their masculinity, level of intimacy, self-confidence, and quality of life (Bokhour, Clark, Inui, Silliman, & Talcott, 2001;Chartier-Kastler et al, 2008;Meyer, Gillatt, Lockyer, & Macdonagh, 2003;Mulhall & Morgentaller, 2007;Wittmann et al, 2009). Eleven men (35%) declined treatment, waiting for spontaneous recovery.…”

“…This wide range of reported outcomes may be due to various methods of investigations, different definitions of preserved sexual function, diversity of surgeons' experience, and different techniques used for nerve-sparing surgeries. A recent study has pointed out that urologists tend to underestimate patients' distress regarding their sexual function post-RRP and their desire for early treatment (Chartier-Kastler et al, 2008). The commonly used term BNS-RRP may act to facilitate the decision in favor of surgery for many men with prostate cancer.…”