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1.
Int Braz J Urol ; 45(6): 1196-1203, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31808408

RESUMO

AIMS: Radical prostatectomy (RP) can result in urinary incontinence (UI) and erectile dysfunction (ED), which negatively impact quality of life (QoL). This study aimed to evaluate the effects of a perioperative pelvic floor muscle training (PFMT) program versus usual care on early recovery of urinary continence and erectile function after RP. MATERIALS AND METHODS: Of 59 eligible men, 31 were randomly allocated into 2 groups: Group 1 (Control, N=15) received usual post-RP care; and Group 2 (Physical therapy, N=16) received two pre-RP physical therapist-guided PFMT sessions, including exercises and electromyographic biofeedback, and verbal and written instructions to continue PFMT until RP, which was then resumed after urethral catheter removal. The International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and the 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire were used to evaluate UI and ED, respectively. RESULTS: Demographic characteristics were similar in both groups. Three months after RP, the UI rate was 72.7% and 70.0% in Groups 1 and 2, respectively (P >0.05). The severity and frequency of UI and its impact on QoL were evaluated by the ICIQ-Short Form, with scores of 6.9±6.26 in Group 1 and 7.0±5.12 in Group 2 (P >0.05). The IIEF-5 scores were similar in Groups 1 and 2 (5.73±7.43 vs. 6.70±6.68, respectively) (P >0.05). CONCLUSION: Our pre-RP protocol of two physical therapist-assisted sessions of PFMT plus instructions did not signifi cantly improve urinary continence or erectile function at 3 months after RP.


Assuntos
Disfunção Erétil/reabilitação , Exercícios de Alongamento Muscular/métodos , Diafragma da Pelve/fisiopatologia , Assistência Perioperatória/métodos , Prostatectomia/reabilitação , Incontinência Urinária/reabilitação , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Idoso , Disfunção Erétil/etiologia , Disfunção Erétil/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Contração Muscular/fisiologia , Gradação de Tumores , Estadiamento de Neoplasias , Neurorretroalimentação , Estudos Prospectivos , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Qualidade de Vida , Inquéritos e Questionários , Resultado do Tratamento , Incontinência Urinária/etiologia , Incontinência Urinária/fisiopatologia
2.
Physiotherapy ; 105(2): 235-243, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30979506

RESUMO

BACKGROUND: Erectile dysfunction (ED) and premature ejaculation (PE) often have underlying musculoskeletal abnormalities. Despite this, traditional management has focused on pharmaceutical prescription. OBJECTIVE: To investigate the efficacy of pelvic floor muscle training in treating ED and PE. DATA SOURCES: A computerized literature search of CINAHL®, Cochrane, InFormit, Ovid Medline, Pedro, and Scopus (from inception until January 2018) was conducted of type of dysfunction and intervention. Secondary search strategies included Medical Subject Headings expansion, hand searching of conference abstracts, key authors, reference lists and forward citation searching via Web of Science. STUDY SELECTION: All studies where participants were males greater than 18years with ED or PE, with no history of neurological injury or previous major urological surgery were included. STUDY APPRAISAL: Two independent reviewers assessed methodological quality using the Crowe Critical Appraisal Tool. Disagreements between reviewers were resolved by consensus. RESULTS: Ten trials were included for review. Among the measures of ED, all trials showed comparative improvement and cure rates in response to treatment. Within PE outcomes, the majority of trials showed comparative improvement rates, with a greater range in overall cure rates in response to treatment. Training protocols varied significantly in overall therapist contact, concurrent interventions, intervention length, training frequency and intensity. LIMITATIONS: The included studies were of low to moderate methodological quality with discrepancies in reporting. Study heterogeneity was not conducive to data pooling. CONCLUSION: Pelvic floor muscle training appears effective in treating ED and PE; however, no optimal training protocol has been identified. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42016047261.


Assuntos
Disfunção Erétil/fisiopatologia , Disfunção Erétil/reabilitação , Terapia por Exercício/métodos , Diafragma da Pelve/fisiopatologia , Ejaculação Precoce/fisiopatologia , Ejaculação Precoce/reabilitação , Humanos , Masculino
3.
Andrologia ; 51(5): e13264, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30873650

RESUMO

Erectile dysfunction could be an early sign of endothelial dysfunction and, therefore, of cardiovascular disease, with which it shares many risk factors. Among reversible risk factors, physical inactivity is one of the most important. Regular physical exercise has been shown to improve erectile function through different mechanisms involving glucose and lipid metabolism, regulation of arterial pressure, production of nitric oxide and hormonal modulation. Furthermore, exercise shows a synergistic effect with the drugs commonly used in the treatment of impotence. Since many patients with erectile dysfunction may have underlying cardiovascular disease, the evaluation of individual cardiovascular risk is mandatory before prescribing physical exercise. When exercise is not contraindicated, the most appropriate protocol must be chosen, considering the individual characteristics of the patient. Both aerobic and anaerobic/resistance protocols have proven effective. However, meta-analytic studies show that aerobic exercise with moderate-to-vigorous intensity is the most effective in improving erection. Testosterone is an important modulator of physical performance, and its blood levels must always be evaluated in patients with erectile dysfunction.


Assuntos
Disfunção Erétil/reabilitação , Exercício/fisiologia , Estilo de Vida , Ereção Peniana/fisiologia , Disfunção Erétil/sangue , Disfunção Erétil/metabolismo , Disfunção Erétil/fisiopatologia , Glucose/metabolismo , Humanos , Metabolismo dos Lipídeos/fisiologia , Masculino , Óxido Nítrico/metabolismo , Fatores de Risco , Testosterona/sangue , Testosterona/fisiologia
4.
Vasc Health Risk Manag ; 14: 393-399, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30584313

RESUMO

Background: Enhanced external counterpulsation (EECP) is a noninvasive treatment option widely applied in patients with erectile dysfunction (ED). The aim of this study is to review the efficacy of EECP in patients suffering from ED. Methods: PubMed, MEDLINE, Google Scholar, Tripdatabase, Scopus, and Cochrane library databases were searched for articles with the following search terms: enhanced external counterpulsation and erectile dysfunction. No restrictions with respect to study setting, date of publication, and language were imposed. Results: From an initial set of 208 records, 4 studies were selected after a final review. A total of 177 patients with a mean age of 59.98 years were included in these studies, with 20-35 hours per week of EECP treatment. Three studies used the International Index of Erectile Function questionnaire and one applied a four-item questionnaire and a peak systolic flow measurement. All of these parameters were significantly improved after the EECP treatment. Conclusion: To the best of our knowledge, this is the first study reviewing the clinical effectiveness of EECP in patients with ED. According to the articles reviewed in this study, an improvement in erectile function after EECP treatment courses has been observed in patients with and without coronary artery disease without any significant adverse effects.


Assuntos
Contrapulsação , Disfunção Erétil/reabilitação , Ereção Peniana , Disfunção Erétil/diagnóstico , Disfunção Erétil/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Resultado do Tratamento
5.
Cochrane Database Syst Rev ; 10: CD012414, 2018 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-30352488

RESUMO

BACKGROUND: Despite efforts to preserve the neurovascular bundles with nerve-sparing surgery, erectile dysfunction remains common following radical prostatectomy. Postoperative penile rehabilitation seeks to restore erectile function but results have been conflicting. OBJECTIVES: To evaluate the effects of penile rehabilitation strategies in restoring erectile function following radical prostatectomy for prostate cancer. SEARCH METHODS: We performed a comprehensive search of multiple databases (CENTRAL, MEDLINE, Embase), the Cochrane Library, Web of Science, clinical trial registries (ClinicalTrials.gov, International Clinical Trials Registry Platform) and a grey literature repository (Grey Literature Report) from their inception through to 3 January 2018. We also searched the reference lists of other relevant publications and abstract proceedings. We applied no language restrictions. SELECTION CRITERIA: We included randomised or quasi-randomised trials with a parallel or cross-over design. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodological procedures. Two review authors independently screened the literature, extracted data, assessed risk of bias and rated quality of evidence according to GRADE on a per-outcome basis. Primary outcomes were self-reported potency, erectile function measured by validated questionnaires (with potency defined as an International Index of Erectile Function (IIEF-EF) score of 19 or greater and or an IIEF-5 of score of 17 or greater) and serious adverse events. For all quality of life assessments on a continuous scale, higher values indicated better quality of life. MAIN RESULTS: We included eight randomised controlled trials with 1699 participants across three comparisons. This abstract focuses on the primary outcomes of this review only.Scheduled phosphodiesterase type 5 inhibitors (PDE5I) versus placebo or no treatmentScheduled PDE5I may have little or no effect on short-term (up to 12 months) self-reported potency (risk ratio (RR) 1.13, 95% confidence interval (CI) 0.91 to1.41; very low quality evidence), which corresponds to 47 more men with self-reported potency per 1000 (95% CI 33 fewer to 149 more) and short-term erectile function as assessed by a validated instrument (RR 1.11, 95% CI 0.80 to 1.55; very low quality evidence), which corresponds to 28 more men per 1000 (95% CI 50 fewer to 138 more), but we are very uncertain of both of these findings. Scheduled PDE5I may result in fewer serious adverse events compared to placebo (RR 0.32, 95% CI 0.11 to 0.94; low quality evidence), though this does not appear biologically plausible and may represent a chance finding. We are also very uncertain of this finding. We found no long-term (longer than 12 months) data for any of the three primary outcomes.Scheduled PDE5I versus on-demand PDE5I Daily PDE5I appears to result in little to no difference in both short-term and long-term (greater than 12 months) self-reported potency (short term: RR 0.97, 95% CI 0.62 to 1.53; long term: RR 1.00, 95% CI 0.60 to 1.67; both very low quality evidence); this corresponds to nine fewer men with self-reported short-term potency per 1000 (95% CI 119 fewer to 166 more) and zero fewer men with self-reported long-term potency per 1000 (95% CI 153 fewer to 257 more). We are very uncertain of these findings. Daily PDE5I appears to result in little to no difference in short-term and long-term erectile function (short term: RR 1.00, 95% CI 0.65 to 1.55; long term; RR 0.74, 95% CI 0.48 to 1.14; both very-low quality evidence), which corresponds to zero men with short-term erectile dysfunction per 1000 (95% CI 80 fewer to 125 more) and 119 fewer men with long-term erectile dysfunction per 1000 (95% CI 239 fewer to 64 more). We are very uncertain of these findings. Scheduled PDE5I may result in little or no effects on short-term adverse events (RR 0.69 95% CI 0.12 to 4.04; very low quality evidence), which corresponds to seven fewer men with short-term serious adverse events (95% CI 18 fewer to 64 more), but we are very uncertain of these findings. We found no long-term data for serious adverse events.Scheduled PDE5I versus scheduled intraurethral prostaglandin E1At short-term follow-up, daily PDE5I may result in little or no effect on self-reported potency (RR 1.10, 95% CI 0.79, to 1.52; very low quality evidence), which corresponds to 46 more men per 1000 (95% CI 97 fewer to 241 more). Daily PDE5I may result in a small improvement of erectile function (RR 1.64, 95% CI 0.84 to 3.20; very low quality evidence), which corresponds to 92 more men per 1000 (95% CI 23 fewer to 318 more) but we are very uncertain of both these findings. We found no long-term (longer than 12 months) data for any of the three primary outcomes.We found no evidence for any other comparisons and were unable to perform any of the preplanned subgroup analyses based on nerve-sparing approach, age or baseline erectile function. AUTHORS' CONCLUSIONS: Based on mostly very-low and some low-quality evidence, penile rehabilitation strategies consisting of scheduled PDE5I use following radical prostatectomy may not promote self-reported potency and erectile function any more than on demand use.


Assuntos
Disfunção Erétil/reabilitação , Ereção Peniana/fisiologia , Complicações Pós-Operatórias/reabilitação , Prostatectomia/reabilitação , Neoplasias da Próstata/cirurgia , Alprostadil/administração & dosagem , Esquema de Medicação , Disfunção Erétil/etiologia , Humanos , Masculino , Inibidores da Fosfodiesterase 5/efeitos adversos , Inibidores da Fosfodiesterase 5/uso terapêutico , Prostatectomia/efeitos adversos , Qualidade de Vida , Inquéritos e Questionários , Agentes Urológicos/administração & dosagem , Suspensão de Tratamento/estatística & dados numéricos
6.
Am J Mens Health ; 12(6): 2136-2143, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30182794

RESUMO

Vacuum therapy has been widely used for penile rehabilitation after radical prostatectomy (RP), but its efficacy and safety are unclear. The study was to evaluate the efficacy and safety of the early use of vacuum therapy for post-RP men. Randomized clinical trials were selected according to predefined inclusion and exclusion criteria. RevMan 5.3 software was used for meta-analyses. In total, six randomized controlled trials were included with a total of 273 post-RP patients. The meta-analysis revealed that the early use of vacuum therapy could significantly improve the five-item International Index of Erectile Function and penile shrinkage in post-RP patients. Few adverse events were reported across the included studies. This review suggests that the early use of vacuum therapy appears to have excellent therapeutic effect on post-RP patients and no serious side effects were identified. Due to overall limited quality of the included studies, the therapeutic benefit of vacuum therapy in penile rehabilitation needs be substantiated to a limited degree in the future. Better methodological, large controlled trials are expected to verify the therapeutic effect of vacuum therapy in penile rehabilitation.


Assuntos
Disfunção Erétil/reabilitação , Prostatectomia , Vácuo , Disfunção Erétil/etiologia , Disfunção Erétil/fisiopatologia , Humanos , Masculino , Ereção Peniana , Pênis/fisiopatologia
7.
Int Urol Nephrol ; 50(11): 2007-2014, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30232721

RESUMO

AIM: To evaluate the role of low-intensity extra corporeal shock wave therapy (LI-ESWT) in penile rehabilitation (PR) post nerve-sparing radical cystoprostatectomy (NS-RCP). MATERIALS AND METHODS: This study included 152 sexually active men with muscle invasive bladder cancer. After bilateral NS-RCP with orthotopic diversion by a single expert surgeon between June 2014 and July 2016, 128 patients were available categorized into three groups: LI-ESWT group (42 patients), phosphodiesterase type-5 inhibitors (PDE5i) group (43 patients), and control group (43 patients). RESULTS: Mean age was 53.2 ± 6.5 years. Mean ± SD follow-up period was 21 ± 8 months. During first follow-up FU1, all patients of the three groups had insufficient erection for vaginal penetration; with decrease of preoperative IIEF-EF mean score from 27.9 to 6.9. Potency recovery rates at 9 months were 76.2%, 79.1%, and 60.5% in LI-ESWT, PDE5i, and control groups, respectively. There was statistically significant increase in IIEF-EF and EHS scores during all follow-up periods in all the study groups (p < 0.001). However, there was no significant difference between the three groups during all follow-up periods. Statistical evaluation showed no significant difference in continence and oncological outcomes during all follow-up points among the three groups (p = 0.55 and 0.07, respectively). CONCLUSIONS: During last follow-up, 16% more patients in LI-ESWT group had recovery of potency as compared to the control group. Although the difference is not statistically significant, but of clinical importance. LI-ESWT is safe as oral PDE5i in penile rehabilitation post nerve-sparing radical cystoprostatectomy.


Assuntos
Carcinoma/cirurgia , Cistectomia/reabilitação , Disfunção Erétil/reabilitação , Tratamento por Ondas de Choque Extracorpóreas/métodos , Prostatectomia/reabilitação , Neoplasias da Bexiga Urinária/cirurgia , Adulto , Carcinoma/patologia , Cistectomia/efeitos adversos , Disfunção Erétil/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Fosfodiesterase 5/uso terapêutico , Prostatectomia/efeitos adversos , Recuperação de Função Fisiológica , Resultado do Tratamento , Neoplasias da Bexiga Urinária/patologia
8.
Am J Cardiol ; 122(2): 229-234, 2018 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-29751956

RESUMO

Penile erection is a hemodynamic process consisting of 2 synchronized components in which the first (active) requires proper vascular endothelium functioning, whereas the second one (passive) is based on a veno-occlusive mechanism. Antihypertensive treatment reduces the passive component, often leading to the development of erectile dysfunction (ED), but lifestyle modifications can improve the sexual functioning. The study aimed to evaluate the association between blood pressure (BP) reduction caused by cardiovascular training and the intensity of ED in men with coronary heart disease. A total of 101 men (mean age 59.50 ± 7.93) with ED treated invasively for coronary heart disease and subjected to cardiac rehabilitation were enrolled. Patient characteristics, the International Index of Erectile Function 5 (IIEF-5) questionnaire (IIEF-5), and BP values were collected at baseline and after 6 months of cardiac rehabilitation and were analyzed. Cardiac rehabilitation led to a significant reduction of 5.08 mm Hg in systolic BP (p <0.001) and of 1.60 mm Hg in diastolic BP (p <0.001). The IIEF-5 score (EQ) significantly increased (median 15, interquartile range 11 to 19 vs median 18, interquartile range 12 to 21, p <0.001). Greater improvement in sexual performance was significantly negatively correlated with age, concentration of triglycerides, and high-density lipoprotein, whereas it was positively correlated with the presence of diabetes and baseline IIEF-5 score. After excluding patients with diabetes, a greater decrease in systolic BP was found to be significantly associated with greater improvement in erectile performance. In conclusion, a reduction of arterial BP caused by cardiac training is accompanied by improvement in erectile performance. This effect is the strongest in patients with hypertension and those with dyslipidemia.


Assuntos
Pressão Arterial/fisiologia , Reabilitação Cardíaca/métodos , Doença das Coronárias/reabilitação , Disfunção Erétil/reabilitação , Terapia por Exercício/métodos , Exercício/fisiologia , Ereção Peniana/fisiologia , Doença das Coronárias/complicações , Doença das Coronárias/fisiopatologia , Eletrocardiografia Ambulatorial , Disfunção Erétil/etiologia , Disfunção Erétil/fisiopatologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Tempo
9.
Urologe A ; 57(2): 211-222, 2018 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-29417194

RESUMO

Artificial urinary sphincters and penile corpus cavernosum prostheses are effective for patients who are not adequately treated by conservative treatment or pharmacotherapy. Both of these devices show good results concerning functional outcome if used within the correct patient selection. Penile prostheses are meant to be the last line of treatment for severe erectile dysfunction after failure of conventional treatment. Artificial urinary sphincters are the treatment of choice for severe urinary stress incontinence. Although the surgical procedure is an easy one, only highly experienced centers should perform the implantation due to minimization of infections and loss of function. Because of the hydraulic working principle of both devices, check-ups on a regular basis are strongly recommended. In the case of a loss of function or infections, a rapid and targeted treatment is the key to make new implantations possible in the future.


Assuntos
Disfunção Erétil/cirurgia , Prótese de Pênis , Procedimentos Cirúrgicos Reconstrutivos/métodos , Incontinência Urinária por Estresse/cirurgia , Esfíncter Urinário Artificial , Procedimentos Cirúrgicos Urológicos/métodos , Disfunção Erétil/reabilitação , Humanos , Masculino , Prótese de Pênis/efeitos adversos , Próteses e Implantes , Resultado do Tratamento , Esfíncter Urinário Artificial/efeitos adversos , Urologia
10.
Fisioterapia (Madr., Ed. impr.) ; 40(1): 44-47, ene.-feb. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-171541

RESUMO

Antecedentes y objetivo: La prostatectomía radical se ha convertido en el gold standard para tratar el cáncer de próstata. Se han desarrollado nuevas técnicas quirúrgicas para intentar maximizar los resultados en la resección del tumor y minimizar las secuelas, naciendo así la prostatectomía radical robótica. Aunque parece mostrar unos mejores resultados, el porcentaje de pacientes con secuelas como la incontinencia urinaria y la disfunción eréctil sigue siendo importante. Se ha probado que la fisioterapia puede contribuir a la resolución de estas secuelas acortando los tiempos de curación en la prostatectomía abierta y en la laparoscópica. El objetivo de este trabajo es conocer los efectos del tratamiento de fisioterapia en las secuelas de la prostatectomía radical robótica. Descripción del caso: Paciente de 63 años intervenido de prostatectomía radical robótica por adenocarcinoma de próstata, Gleason 6 (3+3), bilateral. Al inicio del tratamiento el paciente presenta incontinencia muy severa, con una pérdida de 332g en el Pad test 1h y una disfunción severa con una puntuación de 5 en el cuestionario International Index of Erectile Function(IIEF-15). Intervención: Aplicación de un programa de fisioterapia que consiste en toma de conciencia, biofeedback barométrico y electroestimulación intracavitaria, de la musculatura suelo pélvico, realizado 3 días/semana con una duración de 1h durante 32 semanas. Resultados y discusión: El paciente alcanza la función eréctil a los 6 meses, con una puntuación de 26 en el IIEF-15 y la continencia a los 8 meses, con 0g de pérdida en el Pad test 1h


Background and objective: Radical prostatectomy has become the reference method for treating prostate cancer. New surgical techniques have been developed to try to maximize results in tumour resection and minimize sequelae, resulting in radical robotic prostatectomy. Although there appear to be better outcomes, there are still a significant percentage of patients with sequelae, such as urinary incontinence and erectile dysfunction. It has been shown that physiotherapy can contribute to the resolution of these sequelae by shortening healing times in open and laparoscopic prostatectomy. The aim of this study is to determine the effects of physiotherapy treatment on the sequelae of radical robotic prostatectomy. Case report: A 63-year-old patient underwent robotic radical prostatectomy for prostate adenocarcinoma, Gleason 6 (3+3), bilateral. At the beginning of the treatment, the patient had very severe incontinence, with a loss of 332g in the 1-h pad test, and a severe dysfunction with a score of 5 in the International Index of Erectile Function questionnaire (IIEF-15). Intervention: Application of a physiotherapy program consisting of awareness, barometric biofeedback, and intracavitary electrostimulation of the pelvic floor musculature, performed 3 days/week, 1h for 32 weeks. Results and discussion: The patient achieved erectile function at 6 months, with a score of 26 in the IIEF-15, and continence at 8 months, with 0g of loss in the 1-h pad test


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Incontinência Urinária/reabilitação , Disfunção Erétil/reabilitação , Prostatectomia/métodos , Prostatectomia/reabilitação , Modalidades de Fisioterapia , Cuidados Pós-Operatórios/reabilitação , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/reabilitação
11.
J Urol ; 199(6): 1600-1606, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29307683

RESUMO

PURPOSE: It has not been clearly proved in real practice whether early rehabilitation with phosphodiesterase type 5 inhibitors starting immediately after radical prostatectomy improves erectile function recovery more effectively than delayed treatment with the same regimen. We performed a prospective randomized trial to identify this. MATERIALS AND METHODS: Patients with prostate cancer and an IIEF-5 (International Index of Erectile Function-5) preoperative score of 17 or greater were randomly assigned to receive sildenafil 100 mg regularly twice per week for 3 months immediately after urethral catheter removal as the early group or only 3 months after nerve sparing robot-assisted laparoscopic radical prostatectomy as the delayed group. The study primary end point was the full erectile function recovery rate, defined as an IIEF-5 score of 17 or greater, during the 12 months. RESULTS: Of the 120 randomized patients the proportion who achieved full recovery was significantly higher during the 12 months in the early group than in the delayed group (ß = 0.356, p <0.001, generalized estimating equation). After 9 months postoperatively the proportion of patients who achieved full recovery steadily increased to 41.4% at 12 months in the early group while patients in the delayed group showed no further improvement. Thus, full recovery was achieved in only 17.7% of patients at 12 months. Only early sildenafil treatment independently improved full recovery at 12 months (HR 2.943, p = 0.034). CONCLUSIONS: Our trial provides clinical data to suggest that earlier rehabilitation with phosphodiesterase type 5 inhibitors can contribute to the recovery of erectile function after radical prostatectomy in the clinical setting.


Assuntos
Disfunção Erétil/reabilitação , Laparoscopia/efeitos adversos , Inibidores da Fosfodiesterase 5/uso terapêutico , Complicações Pós-Operatórias/reabilitação , Prostatectomia/efeitos adversos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Citrato de Sildenafila/uso terapêutico , Disfunção Erétil/etiologia , Seguimentos , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Ereção Peniana/efeitos dos fármacos , Ereção Peniana/fisiologia , Inibidores da Fosfodiesterase 5/farmacologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Próstata/patologia , Próstata/cirurgia , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Recuperação de Função Fisiológica/efeitos dos fármacos , Procedimentos Cirúrgicos Robóticos/métodos , Citrato de Sildenafila/farmacologia , Fatores de Tempo , Resultado do Tratamento
12.
Curr Oncol ; 25(6): 393-402, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30607114

RESUMO

Purpose: The most prevalent intervention for localized prostate cancer (pca) is radical prostatectomy (rp), which has a 10-year relative survival rate of more than 90%. The improved survival rate has led to a focus on reducing the burden of treatment-related morbidity and improving the patient and partner survivorship experience. Post-rp sexual dysfunction (sdf) has received significant attention, given its substantial effect on patient and partner health-related quality of life. Accordingly, there is a need for sdf treatment to be a fundamental component of pca survivorship programming. Methods: Most research about the treatment of post-rp sdf involves biomedical interventions for erectile dysfunction (ed). Although findings support the effectiveness of pro-erectile agents and devices, most patients discontinue use of such aids within 1 year after their rp. Because side effects of pro-erectile treatment have proved to be inadequate in explaining the gap between efficacy and ongoing use, current research focuses on a biopsychosocial perspective of ed. Unfortunately, there is a dearth of literature describing the components of a biopsychosocial program designed for the post-rp population and their partners. Results: In this paper, we detail the development of the Prostate Cancer Rehabilitation Clinic (pcrc), which emphasizes multidisciplinary intervention teams, active participation by the partner, and a broad-spectrum medical, psychological, and interpersonal approach. Conclusions: The goal of the pcrc is to help patients and their partners achieve optimal sexual health and couple intimacy after rp, and to help design cost-effective and beneficial rehabilitation programs.


Assuntos
Prostatectomia/efeitos adversos , Neoplasias da Próstata/complicações , Neoplasias da Próstata/reabilitação , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/reabilitação , Disfunção Erétil/etiologia , Disfunção Erétil/psicologia , Disfunção Erétil/reabilitação , Feminino , Humanos , Masculino , Prostatectomia/métodos , Neoplasias da Próstata/psicologia , Neoplasias da Próstata/cirurgia , Qualidade de Vida , Pesquisa , Disfunções Sexuais Fisiológicas/psicologia , Apoio Social
13.
J Sex Med ; 14(12): 1496-1503, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29122494

RESUMO

BACKGROUND: Penile rehabilitation, defined as the use of any drug or device at or after radical prostatectomy to maximize erectile function recovery, is commonly used for post-prostatectomy erectile dysfunction; however, conflicting results based on each study make it difficult to give a recommendation for clinical practice. AIM: To clarify the effect of oral phosphodiesterase type 5 inhibitors (PDE5is), vacuum erection devices, intracorporeal injection therapy, and the combination of these treatments on penile rehabilitation. METHODS: A comprehensive publication search was done through the PubMed and Embase databases up to February 8, 2017. The reference lists of the retrieved studies also were investigated. Data were analyzed using STATA 12.0. A fixed- or random-effects model was used to calculate the overall combined odds ratio (OR) or standard mean differences (SMDs). Publication bias was assessed using the Begg and Egger tests. OUTCOMES: Change in sexual function before and after treatment. RESULTS: After screening, 11 randomized controlled trials and 5 case-control studies were included. The overall meta-analysis showed that penile rehabilitation with PDE5is, vacuum erection devices, and intracorporeal injection significantly increased the number of patients with erectile function improvement (OR = 2.800, 95% CI = 1.932-4.059, P = .000) and International Index of Erectile Function (IIEF) score (SMD = 5.896, 95% CI = 4.032-7.760, P = .000). In subgroup analysis based on study design, randomized controlled trials and case-control studies showed that penile rehabilitation increased the number of patients with erectile function improvement (randomized controlled trials: OR = 2.154, 95% CI = 1.600-2.895, P = .000; case-control studies: OR = 2.800, 95% CI = 1.932-4.059, P = .000). Subgroup analysis for PDE5i treatment also only demonstrated an increased patient response rate (OR = 2.161, 95% CI = 1.675-2.788, P = .000) and IIEF scores (SMD = 0.922, 95% CI = 0.545-1.300, P = .000). However, after PDE5i washout, there was no improvement of spontaneous erectile function (OR = 1.027, 95% CI = 0.713-1.478, P = .610). CLINICAL TRANSLATION: This study provides information about the efficacy of penile rehabilitation that can help clinicians decide treatment strategies. STRENGTHS AND LIMITATIONS: This meta-analysis has higher statistical power than each study. Preoperative patient characteristics, various treatment methods, and different follow-up times might bring bias to pooled effects. CONCLUSION: Our meta-analysis confirmed that administration of PDE5is, vacuum erection devices, and intracorporeal injection after radical prostatectomy can increase erection function during treatments. However, current evidence does not support that penile rehabilitation with PDE5is can improve recovery of spontaneous erectile function. Further studies with adequate follow-up and larger samples should be conducted to generate a comprehensive conclusion. Liu C, Lopez DS, Chen M, Wang R. Penile Rehabilitation Therapy Following Radical Prostatectomy: A Meta-Analysis. J Sex Med 2017;14:1496-1503.


Assuntos
Disfunção Erétil/terapia , Prostatectomia/efeitos adversos , Disfunção Erétil/etiologia , Disfunção Erétil/fisiopatologia , Disfunção Erétil/reabilitação , Humanos , Masculino , Ereção Peniana , Pênis/fisiopatologia , Próstata/cirurgia
14.
Prostate Cancer Prostatic Dis ; 20(4): 395-400, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28462944

RESUMO

BACKGROUND: To ascertain 3-year urinary continence (UC) and sexual function (SF) recovery following robot-assisted radical prostatectomy (RARP) for clinically high-risk prostate cancer (PCa). METHODS: Retrospective analyses of a prospectively maintained database for 769 patients with D'Amico high-risk PCa undergoing RARP at two tertiary care centers in the United States and Europe between 2001 and 2014. The association between time since RARP and recovery of UC (defined as 0 pad/one safety liner per day) and SF (defined as sexual health inventory for men (SHIM) score ⩾17) was tested in separate preoperative and post-operative Cox-proportional hazards regression models. Sensitivity analyses were conducted using continence 0 pad per day and erection sufficient for intercourse as end points for UC and SF recovery, respectively. RESULTS: Mean age of the cohort was 62.3 years, and 62.1% harbored ⩾PT3a disease. Nerve sparing (unilateral or bilateral) RARP was performed in 87.7% of patients. Kaplan-Meier estimates of UC recovery at 12, 24 and 36 months after surgery was 85.2%, 89.1% and 91.2%, respectively, while 33.8, 52.3 and 69.0% of preoperatively potent men (preoperative SHIM ⩾17; n=548; 71.3%) recovered SF. Similar results were noted in sensitivity analyses. Patient age and year of surgery were associated with UC and SF recovery; additionally, preoperative SHIM score, degree of nerve sparing, pT3b-T4 disease and surgical margins were associated with SF recovery over the period of observation. CONCLUSIONS: Patients with D'Amico high-risk PCa treated with RARP may continue to recover UC and SF beyond 12 months of surgery and show promising outcomes at 3-year follow-up. Appropriate patient selection and counseling may aid in setting realistic expectations for functional recovery post RARP.


Assuntos
Disfunção Erétil/fisiopatologia , Prostatectomia/reabilitação , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/reabilitação , Idoso , Disfunção Erétil/reabilitação , Disfunção Erétil/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/fisiopatologia , Neoplasias da Próstata/reabilitação , Robótica , Resultado do Tratamento , Coletores de Urina
15.
Sex Med Rev ; 5(3): 387-392, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28372960

RESUMO

INTRODUCTION: Radical prostatectomy (RP) is the most common definitive invasive treatment option for localized prostate cancer. Although the different surgical procedures-open RP, laparoscopic RP, and robot-assisted laparoscopic RP-do not differ significantly for the results of postoperative erectile dysfunction (ED) and continence, the fear of losing erectile function (EF) is often an important factor for preoperatively sexually active men when deciding for or against a procedure. AIM: To review the available literature on rehabilitation of EF after RP and to evaluate the value of the "Kiel concept" against different strategies of phosphodiesterase type 5 inhibitor (PDE5i) low-dose treatments. METHODS: A review of the available literature up to January 2017 was undertaken using the key terms postsurgical ED, penile rehabilitation," PDE5i rehabilitation, and PDE5i daily dose treatment. MAIN OUTCOME MEASURES: As a main outcome measure we chose reviewed different concepts on the rehabilitation of EF after RP, taking into account the clinical background of the Kiel concept. RESULTS: The different therapeutic concepts for rehabilitation of EF after nerve-sparing RP are surprising. The most frequently applied method is application of different PDE5is. Despite different studies on efficacy, the issue of an optimal concept remains unresolved. The reason for this, among others, can be found in the difficulty of comparing different studies, which can vary with respect to the degree of nerve sparing, postoperative preservation of nocturnal erections, concomitant morbidity, and the number and experience of surgeons. CONCLUSION: In 86% of patients, the Kiel concept has been shown to support rehabilitation of EF after nerve-sparing RP with some form of therapeutic method. The Kiel concept is one therapeutic option among other comparable therapeutic options. Osmonov DK, Jünemann KP, Bannowsky A. The "Kiel Concept" of Long-Term Administration of Daily Low-Dose Sildenafil Initiated in the Immediate Post-Prostatectomy Period: Evaluation and Comparison With the International Literature on Penile Rehabilitation. Sex Med Rev 2017;5:387-392.


Assuntos
Disfunção Erétil/reabilitação , Inibidores da Fosfodiesterase 5/uso terapêutico , Prostatectomia/efeitos adversos , Citrato de Sildenafila/uso terapêutico , Disfunção Erétil/tratamento farmacológico , Disfunção Erétil/etiologia , Humanos , Masculino
16.
J Sex Med ; 14(3): 285-296, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28262099

RESUMO

INTRODUCTION: Sexual dysfunction is common in patients after radical prostatectomy (RP) for prostate cancer. AIM: To provide the International Consultation for Sexual Medicine (ICSM) 2015 recommendations concerning prevention and management strategies for post-RP erectile function impairment in terms of preoperative patient characteristics and intraoperative factors that could influence erectile function recovery. METHODS: A literature search was performed using Google and PubMed databases for English-language original and review articles published up to August 2016. MAIN OUTCOME MEASURES: Levels of evidence (LEs) and grades of recommendations (GRs) based on a thorough analysis of the literature and committee consensus. RESULTS: Nine recommendations are provided by the ICSM 2015 committee on sexual rehabilitation after RP. Recommendation 1 states that clinicians should discuss the occurrence of postsurgical erectile dysfunction (temporary or permanent) with every candidate for RP (expert opinion, clinical principle). Recommendation 2 states that validated instruments for assessing erectile function recovery such as the International Index of Erectile Function and Expanded Prostate Cancer Index Composite questionnaires are available to monitor EF recovery after RP (LE = 1, GR = A). Recommendation 3 states there is insufficient evidence that a specific surgical technique (open vs laparoscopic vs robot-assisted radical prostatectomy) promotes better results in postoperative EF recovery (LE = 2, GR = C). Recommendation 4 states that recognized predictors of EF recovery include but are not limited to younger age, preoperative EF, and bilateral nerve-sparing surgery (LE = 2, GR = B). Recommendation 5 states that patients should be informed about key elements of the pathophysiology of postoperative erectile dysfunction, such as nerve injury and cavernous venous leak (expert opinion, clinical principle). CONCLUSIONS: This article discusses Recommendations 1 to 5 of the ICSM 2015 committee on sexual rehabilitation after RP. Salonia A, Adaikan G, Buvat J, et al. Sexual Rehabilitation After Treatment for Prostate Cancer-Part 1: Recommendations From the Fourth International Consultation for Sexual Medicine (ICSM 2015). J Sex Med 2017;14:285-296.


Assuntos
Disfunção Erétil/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Guias de Prática Clínica como Assunto , Prostatectomia/reabilitação , Idoso , Disfunção Erétil/reabilitação , Medicina Baseada em Evidências , Humanos , Cooperação Internacional , Masculino , Pessoa de Meia-Idade , Ereção Peniana/fisiologia , Complicações Pós-Operatórias/reabilitação , Período Pós-Operatório , Prostatectomia/efeitos adversos , Neoplasias da Próstata/cirurgia , Recuperação de Função Fisiológica , Comportamento Sexual
17.
J Sex Med ; 14(3): 297-315, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28262100

RESUMO

INTRODUCTION: Sexual dysfunction is common in patients after radical prostatectomy (RP) for prostate cancer. AIM: To provide the International Consultation for Sexual Medicine (ICSM) 2015 recommendations concerning management strategies for post-RP erectile function impairment and to analyze post-RP sexual dysfunction other than erectile dysfunction. METHODS: A literature search was performed using Google and PubMed database for English-language original and review articles published up to August 2016. MAIN OUTCOME MEASURES: Levels of evidence (LEs) and grades of recommendations (GRs) are provided based on a thorough analysis of the literature and committee consensus. RESULTS: Nine recommendations are provided by the ICSM 2015 committee on sexual rehabilitation after RP. Recommendation 6 states that the recovery of postoperative erectile function can take several years (LE = 2, GR = C). Recommendation 7 states there are conflicting data as to whether penile rehabilitation with phosphodiesterase type 5 inhibitors improves recovery of spontaneous erections (LE = 1, GR = A). Recommendation 8 states that the data are inadequate to support any specific regimen as optimal for penile rehabilitation (LE = 3, GR = C). Recommendation 9 states that men undergoing RP (any technique) are at risk of sexual changes other than erectile dysfunction, including decreased libido, changes in orgasm, anejaculation, Peyronie-like disease, and changes in penile size (LE = 2, GR = B). CONCLUSION: This article discusses Recommendations 6 to 9 of the ICSM 2015 committee on sexual rehabilitation after RP. Salonia A, Adaikan G, Buvat J, et al. Sexual Rehabilitation After Treatment For Prostate Cancer-Part 2: Recommendations From the Fourth International Consultation for Sexual Medicine (ICSM 2015). J Sex Med 2017;14:297-315.


Assuntos
Disfunção Erétil/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Guias de Prática Clínica como Assunto , Prostatectomia/reabilitação , Idoso , Disfunção Erétil/reabilitação , Medicina Baseada em Evidências , Humanos , Cooperação Internacional , Masculino , Pessoa de Meia-Idade , Ereção Peniana/fisiologia , Complicações Pós-Operatórias/reabilitação , Período Pós-Operatório , Prostatectomia/efeitos adversos , Neoplasias da Próstata/cirurgia , Recuperação de Função Fisiológica , Comportamento Sexual
19.
Zhonghua Nan Ke Xue ; 23(8): 675-679, 2017 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-29726639

RESUMO

Erectile dysfunction (ED) is a common male disease. Some related studies show that the prevalence of ED is nearly 52% in men aged 40 to 70 years and is increasing among younger males. Hypoxia is now considered to be an independent risk factor for ED and the mechanisms of hypoxia inducing ED are varied and complicated. Recently, an idea in penile rehabilitation has attracted much attention, which aims at improving erectile function by increasing oxygen supply to the cavernosum and reducing tissue fibrosis and apoptosis. The approaches to achieve non-sexual penile erection by increasing oxygen supply to the cavernosum, such as behavior therapy, medication, vacuum constriction device, and intracavernous injection, can simulate normal sexual erection and help patients with penile rehabilitation. This review focuses on the strategies for non-sexual penile erection in penile rehabilitation.


Assuntos
Disfunção Erétil/reabilitação , Oxigênio/administração & dosagem , Ereção Peniana , Adulto , Idoso , Disfunção Erétil/epidemiologia , Disfunção Erétil/etiologia , Humanos , Hipóxia/complicações , Hipóxia/terapia , Masculino , Pessoa de Meia-Idade , Pênis/irrigação sanguínea , Fatores de Risco
20.
Am J Mens Health ; 11(3): 641-646, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-27561925

RESUMO

The current study sought to clarify the role of phosphodiesterase type 5 inhibitors (PDE-5i) and a vacuum erection device (VED) in penile rehabilitation after laparoscopic nerve-preserving radical proctectomy (LNRP) for rectal cancer. Participants were assigned to one of the following arms-no-intervention, nightly use of sildenafil 25 mg for 3 months after surgery, or concurrent use of nightly sildenafil 25 mg/day for 3 months and a vacuum erection device (VED) 10 to 15 minutes/day for 3 months-in a nonrandomized fashion. All participants had a follow-up of over 12 months prospectively, and patients had baseline, 3-, 6-, and 12-month assessment based on the International Index of Erectile Function-5 (IIEF-5). Seventy-one cases were included in final analyses. In the no-intervention group, the mean baseline IIEF-5 score of 21.9 decreased rapidly to 5.0 at 3 months ( p < .001), 9.2 at 6 months ( p < .001), and stayed at 10.9 at 12 months ( p < .001). In the single therapy group, the mean baseline IIEF-5 score of 22.4 decreased dramatically to 9.0 at 3 months ( p < .001), 14.9 at 6 months ( p = .005), and stayed at 15.1 at 12 months ( p = .005). In the combined therapy group, the mean baseline IIEF-5 score of 23.0 decreased slightly to 15.0 at 3 months ( p = .005), 18.0 at 6 months ( p = .038), and maintained at 18.7 at 12 months ( p = .163). Findings suggested an over 50% decline in the quality of erection function of the patients after LNRP. The early use of PDE-5i alone or combined use of PDE-5i and VED after LNRP maintained erectile function at 12 months.


Assuntos
Disfunção Erétil/reabilitação , Laparoscopia , Ereção Peniana , Inibidores da Fosfodiesterase 5/administração & dosagem , Neoplasias da Próstata/cirurgia , Neoplasias Retais/cirurgia , Vácuo , Adolescente , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Prostatectomia/efeitos adversos , Adulto Jovem
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