Kaufmann S, Al-Najar A, Boy S, Hamann M F, Naumann C M, Fritzer E, Jünemann K P, van der Horst C
Klinik für Urologie und Kinderurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Campus Kiel, Arnold-Heller-Str. 7, 24105, Kiel, Deutschland.
Urologe A. 2010 Apr;49(4):525-9. doi: 10.1007/s00120-009-2190-2.
Postoperative erectile dysfunction (ED) is one of the potential after-effects of radical prostatectomy. The aim of this study was to learn which caregivers inform the patients prior to the intervention about the risk of ED, which individuals the patients discuss this issue with, and whether the patients preoperatively consider use of a PDE5 inhibitor for proerectile therapy after the operation.
Using the IIEF-5 questionnaire, the preoperative erectile function of 110 patients was evaluated after the hospital admission interview. The patients were asked who had informed them about the risk of postoperative ED. They were also asked in whom they had confided to discuss this issue and whether they were prepared to undergo postoperative proerectile therapy with a PDE5 inhibitor. The patients were subsequently assigned to one of two groups: group I, consisting of those with a preoperative IIEF score > or = 21, or group II, those with a preoperative IIEF score <21.
The answers given by groups I and II did not differ significantly. The median patient age was the same, 68, in both groups. In addition to being informed about postoperative ED by the hospital doctor on admission (100%), the patients were informed about this by the following individuals (results for group II in parentheses): board-certified urologist, 81.8% (74%); general practitioner (GP), 27.3%; partner, 12.1% (11.7%); self-help groups, 0% (2.6%); and friends, 3% (6.5%). Patients also discussed the risk of postoperative ED with the following individuals (results for group II in parentheses): local urologist, 66.7% (63.4%); partner, 45.5% (42.9%); hospital doctor, 39.4% (42.9%); GP, 21.2% (23.4%); friends, 9.1% (14.3); or no one, 3% (5.2%). Regarding whether patients were willing to undergo postoperative therapy using a PDE5 inhibitor, 36.4% in group I and 32.5% in group II said yes, 12.1% in group I and 11.7% in group II said no, and 51.5% in group I and 55.8% in group II were undecided.
Irrespective of the patient's erectile status, the hospital doctor and the local urologist informed the patients about the risk of postoperative ED. Satisfactory information delivered by at least two people occurred in over 70% of all cases. The most frequent confidant of the patient for discussing this issue was his local urologist. Fewer than 50% of the patients discussed this topic with their partners. Possible reasons for underestimating the importance of sexual function could be the frequent taboo status of sexuality as a discussion topic in relationships, as well as preoperative distress. These circumstances should be taken into account by offering sufficient information, including that on the availability of postoperative proerectile therapy, for both the patient and his partner as early as possible, i.e., at the stage of choosing a treatment option.
术后勃起功能障碍（ED）是根治性前列腺切除术潜在的后遗症之一。本研究的目的是了解哪些护理人员在干预前告知患者ED的风险，患者与哪些人讨论这个问题，以及患者术前是否考虑术后使用5型磷酸二酯酶（PDE5）抑制剂进行勃起功能恢复治疗。
采用国际勃起功能指数-5（IIEF-5）问卷，在入院访谈后对110例患者的术前勃起功能进行评估。询问患者谁告知了他们术后ED的风险。还询问他们与谁倾诉过这个问题，以及他们是否准备好接受术后使用PDE5抑制剂进行勃起功能恢复治疗。随后将患者分为两组：第一组，术前IIEF评分≥21分者；第二组，术前IIEF评分＜21分者。
第一组和第二组给出的答案没有显著差异。两组患者的中位年龄相同，均为68岁。除了入院时医院医生告知术后ED的风险（100%）外，患者还从以下人员处得知此事（括号内为第二组结果）：获得认证的泌尿外科医生，81.8%（74%）；全科医生（GP），27.3%；伴侣，12.1%（11.7%）；自助小组，0%（2.6%）；朋友，3%（6.5%）。患者还与以下人员讨论过术后ED的风险（括号内为第二组结果）：当地泌尿外科医生，66.7%（63.4%）；伴侣，45.5%（42.9%）；医院医生，39.4%（42.9%）；全科医生，21.2%（23.4%）；朋友，9.1%（14.3%）；或无人讨论，3%（5.2%）。关于患者是否愿意接受术后使用PDE5抑制剂治疗，第一组36.4%、第二组32.5%表示愿意，第一组12.1%、第二组11.7%表示不愿意，第一组51.5%、第二组55.8%表示不确定。
无论患者的勃起状态如何，医院医生和当地泌尿外科医生都会告知患者术后ED的风险。超过70%的病例中至少有两人提供了满意的信息。患者讨论这个问题最常倾诉的对象是当地泌尿外科医生。不到50%的患者与伴侣讨论过这个话题。低估性功能重要性的可能原因包括在人际关系中，性作为讨论话题常常是禁忌，以及术前的痛苦。在选择治疗方案阶段，应尽早为患者及其伴侣提供充分的信息，包括术后勃起功能恢复治疗的可行性等情况，以考虑到这些因素。
