Northshore University HealthSystem, Evanston, IL, USA.
University of Chicago Medical Center, Chicago, USA.
BMC Urol. 2019 Oct 7;19(1):89. doi: 10.1186/s12894-019-0516-y.
A variety of penile rehabilitation (PR) therapies are available to improve post-prostatectomy erectile dysfunction (ED) with mixed results. It is uncertain how adherent men are to PR therapies. The aim of this study is to determine adherence to and identify barriers to PR treatment.
A longitudinal cross-sectional approach was used in men who underwent radical prostatectomy over 2 years. Men were instructed to take a PDE5 inhibitor (PDE5i) three times per week, and if required, utilize a vacuum constriction device (VCD) daily. Outcomes were measured by multiple validated questionnaires. In addition, penile stretched length, side effects, compliance to PR regimen & barriers to participation were documented.
Seventy-seven patients were enrolled, however only 49 completed evaluation at 3 or more timepoints and were included in analysis. This cohort was an average age of 58.1 years (±7.7), had robotic laparoscopic radical prostatectomy (91.7%), and had bilateral nerve sparing procedures (95.8%). Majority (62.5%) reported normal SHIM pre-operatively, however 79% used PDE5i. Erectile function as measured by IIEF and Erection Hardness Rating were negatively affected post-operatively, with gradual improvement in parameters throughout the 24 month follow up. Of the participants who had normal pre-op SHIM, only 23.1 and 28.6% regained baseline function at 1 and 2 years, respectively. Orgasm was significantly diminished immediately post-operatively, however, at the end of the study period only 37% of men reported diminished climax and no men reported absent orgasm. Adherence to penile rehabilitation therapies declined overtime. Men took oral PDE5i on average 2.3 times weekly at 12 and 24 months (p < 0.001). Men used the VCD 2.3-3.9 days a week, which declined overtime (p = 0.014).
Improvement in erectile and orgasm parameters was observed over time, but most men did not return to baseline function. Despite comprehensive instructions and a frequent follow up schedule, PDE5i and VCD adherence was poor. High attrition rates were noted with only 55.8% of men remaining at 12 months and 45% of men completing 24 months. The most common barriers to PR adherence were cost, inconvenience and perceived ineffectiveness.
有多种阴茎康复（PR）疗法可用于改善前列腺切除术后勃起功能障碍（ED），但效果不一。目前尚不清楚男性对 PR 治疗的依从性如何。本研究旨在确定 PR 治疗的依从性和识别障碍。
采用纵向横断面方法对 2 年内接受根治性前列腺切除术的男性进行研究。指导男性每周服用 3 次 PDE5 抑制剂（PDE5i），如果需要，每天使用真空勃起装置（VCD）。通过多项经过验证的问卷来评估结果。此外，还记录了阴茎伸展长度、副作用、PR 方案的依从性和参与的障碍。
共纳入 77 例患者，但只有 49 例在 3 个或更多时间点完成评估并纳入分析。该队列的平均年龄为 58.1±7.7 岁，接受机器人腹腔镜根治性前列腺切除术（91.7%）和双侧神经保留手术（95.8%）。大多数（62.5%）患者术前 SHIM 正常，但 79%使用 PDE5i。IIEF 和勃起硬度评分测量的勃起功能在术后受到影响，随着 24 个月随访时间的延长，参数逐渐改善。在术前 SHIM 正常的患者中，只有 23.1%和 28.6%分别在 1 年和 2 年时恢复到基线功能。术后射精功能明显减弱，但在研究期末，只有 37%的男性报告射精高潮减弱，没有男性报告没有射精高潮。阴茎康复治疗的依从性随时间推移而下降。男性在 12 和 24 个月时平均每周口服 PDE5i2.3 次（p<0.001）。男性每周使用 VCD 2.3-3.9 天，随时间推移而减少（p=0.014）。
随着时间的推移，勃起和射精参数有所改善，但大多数男性并未恢复到基线功能。尽管有全面的指导和频繁的随访计划，但 PDE5i 和 VCD 的依从性很差。只有 55.8%的男性在 12 个月时仍在接受治疗，45%的男性完成了 24 个月的治疗，因此出现了较高的脱落率。PR 依从性的最常见障碍是费用、不便和认为无效。
