Department of Urology, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany.
Department of Urology, Philipps-University Marburg, Baldingerstraße, 35043 Marburg, Germany.
J Sex Med. 2024 Sep 28;21(10):904-911. doi: 10.1093/jsxmed/qdae105.
Studies have shown insufficient utilization of care for patients with erectile dysfunction (ED) after radical prostatectomy (RP).
The aim of this study was to evaluate variables associated with barriers to seeking and receiving ED treatment.
In this multicenter prospective cross-sectional study, the functional outcomes of 936 patients were assessed 10 to 15 years after RP. A total of 525 patients with ED or incontinence were asked about their treatment experiences or lack thereof. The data were analyzed using the chi-square test, t test, and multivariate logistic analyses.
Patients answered validated questionnaires regarding information sources, communication with their partner and urologist, and barriers to ED treatment.
Of the 525 patients, 80 were not available to survey. A total of 304 patients answered the survey (response: 68.0%). A total of 246 patients had ED and were included in this study. The mean age at surgery was 64.4 ± 6.1 years, and the mean age at the time of this survey was 77.1 ± 6.2 years. The mean follow-up duration was 12.7 ± 1.5 years. Forty-six percent (n = 114 of 246) of the patients had never received ED treatment. The most important conversation partners regarding the ED were the partner (69% [n = 169 of 246]) and the urologist (48% [n = 118 of 246]). Patients who never received ED treatment were less likely to have conversations with their urologist (34% vs 60%; P < .001), had less support (51% vs 68%; P = .01), and had less interest in sex from their partner (20% vs 40%; P = .001). Communication with other groups (general practitioners, other physicians, family, friends, and the Internet) had no influence on ED treatment utilization. The most relevant barrier to receiving ED treatment was the belief that treatment would not help (65%). No interest in sex from their partner (odds ratio, 3.9) and no conversation with their urologist about ED (odds ratio, 2.9) were found to be independent predictors of not receiving ED treatment.
Urologists should have enhanced awareness of how to approach patients directly about their ED and actively offer them treatment options.
These results should be further validated in a multicenter, prospective study. Response bias may have affected the results. Furthermore, the current cohort was relatively old.
This study revealed that no interest in sex from one's partner and insufficient communication with a urologist were relevant barriers to insufficient utilization of ED treatment after RP.
研究表明，在接受根治性前列腺切除术（RP）后，患者对勃起功能障碍（ED）的治疗利用不足。
本研究旨在评估与寻求和接受 ED 治疗障碍相关的变量。
在这项多中心前瞻性横断面研究中，评估了 936 例患者在 RP 后 10-15 年的功能结局。对 525 例有 ED 或尿失禁的患者询问了他们的治疗经历或缺乏治疗的情况。使用卡方检验、t 检验和多变量逻辑分析对数据进行了分析。
525 例患者中，80 例无法进行调查。共有 304 例患者回答了调查（应答率：68.0%）。共有 246 例有 ED 并纳入本研究。手术时的平均年龄为 64.4±6.1 岁，本次调查时的平均年龄为 77.1±6.2 岁。平均随访时间为 12.7±1.5 年。46%（n=246 例中有 114 例）的患者从未接受过 ED 治疗。关于 ED，最重要的谈话伙伴是伴侣（69%[n=246 例中有 169 例]）和泌尿科医生（48%[n=246 例中有 118 例]）。从未接受 ED 治疗的患者与泌尿科医生交谈的可能性较小（34%比 60%；P<0.001），支持度较低（51%比 68%；P=0.01），对伴侣的性兴趣较低（20%比 40%；P=0.001）。与其他群体（全科医生、其他医生、家庭、朋友和互联网）的交流对 ED 治疗的利用没有影响。接受 ED 治疗的最大障碍是认为治疗没有帮助（65%）。对伴侣缺乏性兴趣（比值比，3.9）和与泌尿科医生就 ED 问题没有交谈（比值比，2.9）被认为是未接受 ED 治疗的独立预测因素。
泌尿科医生应提高直接与患者讨论 ED 的意识，并积极为他们提供治疗选择。
这些结果应在多中心前瞻性研究中进一步验证。可能存在应答偏倚。此外，目前的队列相对较老。
本研究表明，对伴侣缺乏性兴趣和与泌尿科医生沟通不足是 RP 后 ED 治疗利用不足的相关障碍。
