对于接受前列地尔阴茎海绵体内注射治疗超过 1 年的根治性前列腺切除术后患者，继续进行性康复治疗是否有价值？
Is it worth continuing sexual rehabilitation after radical prostatectomy with intracavernous injection of alprostadil for more than 1 year?
机构信息
Department of Urology, Henri Mondor Teaching Hospital Créteil, France.
Department of Public Health, LIC EA4393, Université Paris Est (UPEC), Henri Mondor Teaching Hospital Créteil, France.
出版信息
Sex Med. 2015 Mar;3(1):42-8. doi: 10.1002/sm2.51.
INTRODUCTION
Intracavernous alprostadil injection (IAI) is a widely used treatment for sexual rehabilitation (SR) after radical prostatectomy (RP). It is unknown whether the continuation of IAI beyond 1 year continues to improve erectile function.
AIMS
To assess evolution of sexual function in patients using IAI who are nonresponsive to phosphodiesterase type 5 inhibitors (PDE5i) between 12 (M12) and 24 (M24) months after RP.
METHODS
We retrospectively studied 75 men with a nerve-sparing laparoscopic RP, who had normal preoperative erectile function, and who regularly used IAI for SR for at least 24 months. At M12, no patients had responded to PDE5i.
MAIN OUTCOME MEASURES
At 12 and 24 months, sexual function was assessed with the UCLA Prostate Cancer Index (UCLA-PCI), International Index of Erectile Function (IIEF)-15, and erection hardness score (EHS) with and without IAI. We also assessed the satisfaction rate with IAI, injection-related penile pain, and satisfaction of treatment. Statistical analysis was performed by using t-tests for paired data and Spearman's rho correlation coefficients to assess the relationships between scores at M12 and M24.
RESULTS
Improvement of nocturnal erection was noted (UCLA-PCI, question 25); however, no significant difference was found for IIEF-erectile function with (19.60 ± 9.80 vs. 18.07 ± 10.44) and without IAI (4.63 ± 2.93 vs. 4.92 ± 4.15), UCLA-PCI-sexual bother (37.14 ± 21.45 vs. 37.54 ± 19.67), nor the EHS score with (2.97 ± 1.30 vs. 2.57 ± 1.30) and without IAI (0.67 ± 1.11 vs. 0.76 ± 0.10). The rate of satisfaction with treatment decreased over time (66.6% vs. 46.7%, P = 0.013). Improved response to IAI at M12 was not correlated to improvement in spontaneous erections at M24.
CONCLUSION
The response to IAI remained stable after 2 years of treatment, and no significant improvement of spontaneous erections during intercourse attempts was found between M12 and M24. Patients should be informed of the limited effect of IAI on natural erections after 1 year. Yiou R, Bütow Z, Parisot J, Binhas M, Lingombet O, Augustin D, de la Taille A, and Audureau E. Is it worth continuing sexual rehabilitation after radical prostatectomy with intracavernous injection of alprostadil for more than 1 year? Sex Med 2015;3:42-48.
简介
经尿道前列腺切除术（RP）后，阴茎海绵体内前列腺素 E1 注射（IAI）是一种广泛应用的治疗方法，用于恢复性功能（SR）。目前还不清楚在 RP 后 1 年以上继续使用 IAI 是否能继续改善勃起功能。
目的
评估在 RP 后至少 24 个月持续使用 IAI 进行 SR 的患者，在 12 个月（M12）和 24 个月（M24）时对磷酸二酯酶 5 抑制剂（PDE5i）无反应的患者的性功能变化。
方法
我们回顾性研究了 75 例接受腹腔镜保留神经 RP 的男性患者，他们术前勃起功能正常，并且至少连续 24 个月定期使用 IAI 进行 SR。在 M12 时，没有患者对 PDE5i 有反应。
主要观察指标
在 12 个月和 24 个月时，使用加利福尼亚大学洛杉矶分校前列腺癌指数（UCLA-PCI）、国际勃起功能指数（IIEF-15）和勃起硬度评分（EHS）评估患者的性功能，包括有无 IAI。我们还评估了患者对 IAI 的满意度、注射相关的阴茎疼痛和治疗满意度。使用配对 t 检验和斯皮尔曼 rho 相关系数对 M12 和 M24 时的评分进行分析，以评估评分之间的关系。
结果
夜间勃起改善（UCLA-PCI，问题 25）；然而，使用 IAI 前后 IIEF 勃起功能（19.60±9.80 vs. 18.07±10.44）和无 IAI （4.63±2.93 vs. 4.92±4.15）、UCLA-PCI 性困扰（37.14±21.45 vs. 37.54±19.67）和 EHS 评分（2.97±1.30 vs. 2.57±1.30）均无显著差异，也无 IAI （0.67±1.11 vs. 0.76±0.10）。治疗满意度随时间下降（66.6% vs. 46.7%，P=0.013）。M12 时 IAI 反应的改善与 M24 时自发性勃起的改善无相关性。
结论
IAI 治疗 2 年后反应保持稳定，在 M12 和 M24 之间，在尝试自然性交时，自发性勃起无明显改善。患者应被告知，IAI 在 1 年后对自然勃起的效果有限。
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