Urology Centre, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, Great Maze Pond, London, UK.
BJU Int. 2012 Jan;109(2):254-8. doi: 10.1111/j.1464-410X.2011.10237.x. Epub 2011 Aug 25.
To determine whether preoperative demonstrations of intracavernosal and vacuum therapies for erectile dysfunction (ED) influence the decision of treatment choice, reducing long-term regret.
In all, 82 consecutive men with localized prostate cancer, scheduled for radical prostatectomy and reporting an International Index of Erectile Function score of >21, were prospectively enrolled at a single cancer centre. Following standard preoperative counselling, half of the men were invited to attend a further consultation for intracavernosal and vacuum therapy demonstrations. All patients were evaluated pretreatment and then 3 monthly using the five-point International Index of Erectile Function score and the 14-item Hospital Anxiety and Depression scale. At 12 months treatment choice changes were recorded and patients were assessed for treatment choice regret using Clark's validated two-item regret questionnaire. Statistical analysis was performed using the Mann-Whitney and Fisher's exact tests. Results were compared with a control population of 41 men who did not undergo additional ED counselling.
In all, 8/41 men (19%) changed their treatment choice, opting for brachytherapy rather than radical prostatectomy. Only 1/41 in the control population changed their decision before surgery. At 1 year, one patient (2%) in the intervention group expressed regret at his treatment choice (radical prostatectomy) compared with eight (20%) in the control group (P= 0.03, two-sided Fisher's exact test); ED was identified as the major cause of this regret.
Preoperative demonstrations of ED therapies can optimize decision making in prostate cancer and help reduce long-term regret.
确定勃起功能障碍（ED）的海绵体内和真空治疗的术前演示是否会影响治疗选择的决策，从而减少长期遗憾。
共有 82 名连续的局限性前列腺癌患者，计划接受根治性前列腺切除术，且国际勃起功能指数评分>21 分，在一个癌症中心前瞻性入组。在进行标准的术前咨询后，一半的患者被邀请参加海绵体内和真空治疗演示的进一步咨询。所有患者在治疗前和 3 个月时使用 5 分制国际勃起功能指数评分和 14 项医院焦虑和抑郁量表进行评估。在 12 个月时记录治疗选择的变化，并使用 Clark 的经验证的两项后悔问卷评估患者对治疗选择的后悔情况。使用 Mann-Whitney 和 Fisher 精确检验进行统计分析。结果与未接受额外 ED 咨询的 41 名男性对照人群进行比较。
共有 8/41 名男性（19%）改变了治疗选择，选择了近距离放射治疗而不是根治性前列腺切除术。在对照组中，只有 1/41 名患者在手术前改变了决定。在 1 年时，干预组中有 1 名患者（2%）对其治疗选择（根治性前列腺切除术）表示后悔，而对照组中有 8 名患者（20%）表示后悔（P=0.03，双侧 Fisher 精确检验）；ED 被认为是这种后悔的主要原因。
ED 治疗的术前演示可以优化前列腺癌的决策，并有助于减少长期遗憾。
