Abstract:Background: Patients may remain dissatisfied after penile prosthesis implantation for the treatment of erectile dysfunction. Studies showing the results of standardized protocols for preoperative psychological evaluation are lacking. Purpose: To estimate the rate of patients considered psychologically unfit for penile prosthesis implantation and to compare their characteristics with those considered fit after the implementation of a standardized psychological profile evaluation protocol for men with erectile d… Show more
“…In addition to directly querying psychiatric history, a review of current medications may indicate ongoing treatment for psychiatric conditions. A history of psychiatric comorbidities may suggest increased risk for dissatisfaction, but the more important aspect of this initial assessment is to determine if a patient has active, untreated symptoms that may require additional support ( 11 ). Patients with poorly managed psychiatric conditions may not have the psychological reserve or ability to cope with a significant complication.…”
Section: Preoperative Considerationsmentioning
confidence: 99%
“…Previous studies have demonstrated that the incidence of anxiety or depressive symptoms is 13.8–17.1% in men with ED ( 11 ). Failure to recognize psychiatric comorbidities may lead to surgical complications, prolonged hospital stay, readmission, and overall decreased patient satisfaction ( 12 - 15 ).…”
Background and Objective
Treatment for medication-refractory erectile dysfunction (ED) is based on a shared decision-making model. The gold standard treatment for medication refractory ED is penile prosthesis (PP) placement. Patient satisfaction rates with PP are high with adequate counseling and expectation-setting. However, as with any elective surgery, patient selection is key to minimizing complications and ultimately patient dissatisfaction. Psychological well-being is an important consideration in the preoperative evaluation and postoperative management of patients undergoing PP placement.
Methods
We performed a PubMed literature review to identify pertinent studies for this narrative review. Specifically, we sought describe preoperative evaluation including appropriate counseling and patient selection as well relevant intraoperative and postoperative factors for patients undergoing PP placement with a specific focus on optimizing preoperative psychiatric factors and treatment-related patient satisfaction to identify pertinent articles describing ways to optimize patient satisfaction with PP.
Key Content and Findings
A patient’s psychological state can influence the degree of understanding of their condition, affect perception of their treatment team, and limit their ability to cope with complications. All patients should undergo a thorough medical history and physical examination to screen for psychiatric health disorders, substance abuse, and chronic pain conditions. Establishing patient expectations with regards to treatment-related outcomes during the preoperative consultation will ensure congruency between the patient and performing surgeon. Patients with a more significant psychiatric distress related to their underlying sexual dysfunction may require additional evaluation and counseling preoperatively.
Conclusions
PP placement is associated with high levels of overall satisfaction in appropriately screened patients. Specific considerations during preoperative counseling and careful patient selection, intraoperative decision making to avoid or anticipate possible complications, and postoperative cares are necessary to ensure the best result for an individual patient.
“…In addition to directly querying psychiatric history, a review of current medications may indicate ongoing treatment for psychiatric conditions. A history of psychiatric comorbidities may suggest increased risk for dissatisfaction, but the more important aspect of this initial assessment is to determine if a patient has active, untreated symptoms that may require additional support ( 11 ). Patients with poorly managed psychiatric conditions may not have the psychological reserve or ability to cope with a significant complication.…”
Section: Preoperative Considerationsmentioning
confidence: 99%
“…Previous studies have demonstrated that the incidence of anxiety or depressive symptoms is 13.8–17.1% in men with ED ( 11 ). Failure to recognize psychiatric comorbidities may lead to surgical complications, prolonged hospital stay, readmission, and overall decreased patient satisfaction ( 12 - 15 ).…”
Background and Objective
Treatment for medication-refractory erectile dysfunction (ED) is based on a shared decision-making model. The gold standard treatment for medication refractory ED is penile prosthesis (PP) placement. Patient satisfaction rates with PP are high with adequate counseling and expectation-setting. However, as with any elective surgery, patient selection is key to minimizing complications and ultimately patient dissatisfaction. Psychological well-being is an important consideration in the preoperative evaluation and postoperative management of patients undergoing PP placement.
Methods
We performed a PubMed literature review to identify pertinent studies for this narrative review. Specifically, we sought describe preoperative evaluation including appropriate counseling and patient selection as well relevant intraoperative and postoperative factors for patients undergoing PP placement with a specific focus on optimizing preoperative psychiatric factors and treatment-related patient satisfaction to identify pertinent articles describing ways to optimize patient satisfaction with PP.
Key Content and Findings
A patient’s psychological state can influence the degree of understanding of their condition, affect perception of their treatment team, and limit their ability to cope with complications. All patients should undergo a thorough medical history and physical examination to screen for psychiatric health disorders, substance abuse, and chronic pain conditions. Establishing patient expectations with regards to treatment-related outcomes during the preoperative consultation will ensure congruency between the patient and performing surgeon. Patients with a more significant psychiatric distress related to their underlying sexual dysfunction may require additional evaluation and counseling preoperatively.
Conclusions
PP placement is associated with high levels of overall satisfaction in appropriately screened patients. Specific considerations during preoperative counseling and careful patient selection, intraoperative decision making to avoid or anticipate possible complications, and postoperative cares are necessary to ensure the best result for an individual patient.
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