Yiou R, Khodari M, Lingombet O, Rudy M, Mine V, de la Taille A, Salomon L, Abbou C
Service d'urologie, CHU Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
Prog Urol. 2011 Apr;21(4):283-7. doi: 10.1016/j.purol.2010.09.020. Epub 2010 Dec 13.
To evaluate a nurse educational program for penile rehabilitation after radical prostatectomy (RP) based on intracavernous alprostadil injection (IAI).
One hundred consecutive patients started IAI one month after RP under the supervision of a nurse practitioner (day 0). Patients performed the first injection (2.5 μg); they were advised to increase gradually the dose of alprostadil until having satisfactory erections. Patients having difficulties with IAI were called back by the nurse. They received a medical follow-up at the uro-oncology department at 6 months. We assessed at D0, D15 and at 6 months: the ability to complete the IAI, the occurrence of priapism, the injected doses, the recovery of sexual function (EHS and GAQ scores), and pain in erection (numeric rating scale).
Eighty-one percent of patients were very satisfied with the educational program. On day 15, 93% of patients achieved IAI (mean injected dose: 5.2 μg). No priapism was noted. The treatment had ameliorated erections in 80% of cases (GAQ); 47% of patients had erections hard enough to allow penetration (EHS>2) and 39% had sexual intercourses. Pain to erection (3.9/10 on average) represented a motive of request for recall for 2/3 of the patients. At 6 months, the dropout rate was 31%; mean pain level, EHS score and injected dose were respectively 3.2/10, 2.9/4 and 8.8 μg.
The nurse educational program for penile rehabilitation after RP was associated with satisfactory rates of self-injection accomplishment and treatment observance. However, close and prolonged follow up was necessary because of post-IAI penile pain.
评估一项基于海绵体内注射前列地尔（IAI）的前列腺癌根治术（RP）后阴茎康复护理教育项目。
100例连续患者在执业护士的监督下于RP术后1个月开始IAI治疗（第0天）。患者进行首次注射（2.5μg）；建议他们逐渐增加前列地尔剂量，直至获得满意勃起。IAI有困难的患者由护士召回。他们在6个月时接受了泌尿肿瘤科的医学随访。我们在第0天、第15天和6个月时评估：完成IAI的能力、阴茎异常勃起的发生率、注射剂量、性功能恢复情况（国际勃起功能指数和全球勃起功能问卷评分）以及勃起疼痛（数字评分量表）。
81%的患者对该教育项目非常满意。在第15天，93%的患者完成了IAI（平均注射剂量：5.2μg）。未观察到阴茎异常勃起。80%的病例中治疗改善了勃起情况（全球勃起功能问卷）；47%的患者勃起硬度足以进行性交（国际勃起功能指数>2），39%的患者进行了性交。勃起疼痛（平均3.9/10）是2/3患者要求召回的原因。在6个月时，失访率为31%；平均疼痛程度、国际勃起功能指数评分和注射剂量分别为3.2/10、2.9/4和8.8μg。
RP术后阴茎康复护理教育项目与自我注射完成率和治疗依从率令人满意相关。然而，由于IAI后阴茎疼痛，密切和长期的随访是必要的。
