Lerner S E, Richards S L, Benet A E, Kahan N Z, Fleischmann J D, Melman A
Service d'Urologie, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York 10467, USA.
Prog Urol. 1996 Aug-Sep;6(4):552-7.
Post radical prostatectomy potency rates, quantified on the basis of physician survey, have ranged up to 80%. Physician derived potency data, however, may not be representative of true post-prostatectomy potency rates or more importantly may not accurately portray patients' post-operative sexual satisfaction. We conducted a pilot study combining physician derived and patient derived subjective data with objective measures of erectile function.
Eleven men, mean age of 59 years, who were treated with nerve sparing radical retropubic prostatectomy formed the study group. Initially, the patients responded to a physician directed telephone survey on sexual status. Potency was then objectively assessed utilizing Rigiscan testing on two consecutive evenings. Lastly, the patients completed a validated short questionnaire directed to obtain a patients' subjective perception of sexual function.
All the patients responded to the first part of the study by informing the physician that they were sexually active or potent after radical prostatectomy. Of these 11 patients, however, only 2 (18%) were mostly satisfied with their sex life according to the quality of life questionnaire. Rigiscan testing revealed that 8 of the 11 patients had nocturnal erections which were adequate for vaginal penetration. Of the 5 patients who stated that they were mostly dissatisfied with their sexual functioning, 3 had objective evidence of adequate erectile ability as documented by Rigiscan. Three of the four patients who were ambivalent with respect to their sexual function also demonstrated objective evidence of normal erectile activity.
Although a patient may inform his care provider that he is sexually active or potent, he may not be satisfied with his present level of sexual functioning. In addition, we observed that some dissatisfied patients do have normal Rigiscan patterns indicating that a percentage of patients who are not happy with their level of sexual function after radical prostatectomy may have a psychogenic component to their problem.
根据医生调查得出的前列腺癌根治术后性功能恢复率高达80%。然而，医生提供的性功能恢复数据可能并不代表前列腺癌根治术后的真实性功能恢复率，更重要的是，可能无法准确描述患者术后的性满意度。我们进行了一项试点研究，将医生提供的主观数据、患者提供的主观数据与勃起功能的客观测量相结合。
11名平均年龄为59岁、接受保留神经的耻骨后前列腺癌根治术的男性组成了研究组。最初，患者通过医生指导的电话调查对性功能状况做出回应。然后，在连续两个晚上使用Rigiscan测试对性功能进行客观评估。最后，患者完成一份经过验证的简短问卷，以获取患者对性功能的主观感受。
所有患者都对研究的第一部分做出了回应，告知医生他们在前列腺癌根治术后仍有性活动或性功能恢复。然而，根据生活质量问卷，这11名患者中只有2名（18%）对他们的性生活基本满意。Rigiscan测试显示，11名患者中有8名有夜间勃起，足以进行阴道性交。在5名表示对性功能基本不满意的患者中，有3名有Rigiscan记录的足够勃起能力的客观证据。在4名对性功能态度矛盾的患者中，有3名也表现出正常勃起活动的客观证据。
虽然患者可能告知其护理人员他仍有性活动或性功能恢复，但他可能对目前的性功能水平不满意。此外，我们观察到一些不满意的患者确实有正常的Rigiscan模式，这表明一部分前列腺癌根治术后对性功能水平不满意的患者可能存在心理因素。
