Perioperative Educational Interventions and Contemporary Sexual Function Outcomes of Radical Prostatectomy

Impact of improving educational nursing interventions in perioperative nursing interventions on outcomes of prostate cancer patients with laparoscopic radical prostatectomy

Background

Recent studies have reported that perioperative nursing intervention (PNI) plays important roles in the outcomes of prostate cancer (PC) patients undergoing laparoscopic radical prostatectomy (LRP). This study aimed to further investigate the role of educational nursing intervention in PNI on the recovery of PC patients with LRP.

Methods

A total of 98 PC patients who underwent LRP were enrolled in this study. These patients were randomly divided into control (n = 49) and experimental (n = 49). Both groups received routine PNI, while the experimental group also received personalised PNI with enhanced educational nursing interventions. The study compared blood loss during surgery, surgery success rate, clinical signs of intestinal motility, postoperative hospital stay and postoperative complications between these two groups.

Results

Both the control and experimental groups achieved a 100% surgery success rate. The experimental group experienced significantly less blood loss. Moreover, the recovery of intestinal function was faster, and the postoperative hospital stay was shorter in the experimental group. Furthermore, the incidence of postoperative complications was lower in the experimental group.

Conclusion

Our findings confirmed the importance of enhanced educational nursing interventions in personalised perioperative nursing care for PC patients undergoing LRP.

Evaluating the Oncological and Functional Outcomes in 167 Patients Undergoing Laparoscopic Radical Prostatectomy: Could Laparoscopy Still be a Viable Option in Suitable Patients?

Aim: To evaluate the oncological and functional outcomes of 167 patients who underwent laparoscopic radical prostatectomy (LRP). Materials and Methods: The retrospective study included 167 patients who were treated with LRP due to clinically localized prostate cancer between January 2007 and April 2012. Most of the patients were treated with the extraperitoneal approach. Preoperative evaluations included age, serum prostate-specific antigen (PSA) level, and biopsy Gleason score. Perioperative evaluations included duration of operative time and anastomosis time, blood loss (milliliter), and complications. Postoperative evaluations included length of hospital stay and catheterization time. Continence and erectile function were evaluated both pre- and postoperatively. The patients who used no pads or no more than one pad daily and the ones who had only a few urine leakages on effort or exertion were accepted as continent. Postoperative potency was defined as the ability to achieve sexual intercourse with or without the use of PDE-5 inhibitors. Results: Mean age and mean operative time were 62.4 ± 6.0 years and 220.5 ± 45.6 minutes, respectively. Mean anastomosis time was 35.6 ± 9.8 minutes. Mean serum PSA level and mean Gleason score were 17.5 ± 9.97 ng/mL and 6.16 ± 0.42, respectively. Pelvic lymphadenectomy was performed in 94 patients and nerve-sparing procedures in 61 patients. The pathological analysis revealed positive surgical margin in 35 patients (20.9%). Bilateral and unilateral nerve-sparing LRP procedures were performed in 51 (30.5%) and 10 (6%) patients, respectively. At 12 months after surgery, 3 (1.8%) patients were using 2 or more pads per day, 19 (26.4%) patients were satisfied with erection, hardness, and duration of intercourse, and 9 (12.5%) patients had an erection with insufficient hardness and duration. Conclusion: LRP is an acceptable method in localized prostate cancer due to its perioperative and early postoperative results.

Empowerment-Based Education in Urological Patients: A Scoping Review

Prostate, kidney, and bladder cancer are the three most frequently diagnosed urological cancers. Educational programs could teach patients to become experts in disease management. The aim of this scoping review was to explore the literature to identify the educational requirements and strategies for improving and implementing educational processes for urological patients undergoing surgery. We searched several databases, including PubMed, CINAHL, Embase, Scopus, PsycINFO, and Cochrane Library. All adult patients undergoing urological educational interventions were included in the review. Of 3,197 initially identified articles, 42 were retained. Urological patients undergoing prostatectomy, cystectomy, and nephrectomy require cognitive, psychological, and functional support. For each level of support, several methods exist to provide support, including informational brochures, preoperative counseling, telephone support, online content, educational videos, support groups, individual stress management interventions, peer support, online interventions, partner support, and various educational programs that help the patient manage negative effects associated with the urological intervention.

Prostate Cancer From a Sex and Gender Perspective: A Review

INTRODUCTION

Factors influencing patient behavior regarding risk of prostate cancer (PCa) and outcomes of PCa treatments are poorly understood. Similarly, how PCa treatments affect patient sexual function and sense of their masculinity has not been fully investigated. A better understanding of the relationship between sex and gender for patients with PCa could significantly improve their care and quality of life.

OBJECTIVES

To review how concerns about sex and gender influence men's attitudes toward PCa screening, diagnosis, and treatment. To explore how PCa influences sexual function and self-perceived masculine identity. To examine contexts for PSA screening for transgender individuals.

METHODS

We reviewed biomedical and sociological literature exploring the impact of PCa on patient sexual function and self-perceived masculinity using OVID, PubMed, and other databases. We similarly reviewed how masculine gender norms influence patient willingness to engage with PCa screening, diagnoses, and treatment.

RESULTS

Gender norms and sexual function concerns influence patient engagement in all aspects of PCa care. This includes PSA screening, digital rectal examinations, active surveillance, and androgen deprivation therapy (ADT) amongst others. ADT is particularly challenging to sexual function, self-esteem, and masculine identity. Our research suggests that sex and gender are not separate concepts, but rather tightly intertwined, particularly when dealing with the realities experienced by patients with PCa.

CONCLUSION

Interventions to help patients deal with the challenges of PCa and its treatment are likely to be most effective if they concurrently address patients' sexual needs and understanding of gender norms. PSA screening should be considered for transgender individuals who are at greater risk of cancer and on long-term hormone therapy. More research is needed on how concerns over sex and gender influence PCa screening, diagnosis, and treatment. There is also a need for long term data on the oncological outcomes of prolonged exposure to hormone therapy for patients who are transgender. Muermann MM, Wassersug RJ. Prostate Cancer From a Sex and Gender Perspective: A Review. Sex Med Rev 2021;XX:XXX-XXX.

Experiences of Support for Sexual Dysfunction in Men With Prostate Cancer: Findings From a U.K.-Wide Mixed Methods Study

BACKGROUND

Men with prostate cancer (PCa) often experience sexual dysfunction following diagnosis and treatment, yet little is known about the support they receive to deal with this.

AIM

To explore men's experiences of support for sexual dysfunction following PCa diagnosis.

METHODS

This study included a U.K.-wide survey of men 18-42 months post-diagnosis of PCa, identified through cancer registries. The survey measured sexual function and the extent to which men perceived sexual dysfunction to be a problem (Expanded Prostate Cancer Index Composite-26), access to and experience of medications, devices, and specialist services for sexual dysfunction, and included a free-text question for further comments. Analysis focussed on men who reported poor sexual function, which they considered a moderate or big problem. Descriptive statistics explored the characteristics of men offered intervention and those that found this helpful. Free-text responses were analyzed using thematic analysis.

OUTCOME

The main outcome of this study was to assess access to and experience of medications, devices, and specialist services for sexual dysfunction.

RESULTS

39.0% of all survey respondents (13,978/35,823) reported poor sexual function, which they considered a moderate or big problem. 51.7% of these men were not offered any intervention to aid sexual functioning. 71.9% of those offered an intervention reported trying it, of whom 48.7% found the intervention helpful. Men treated with surgery or brachytherapy were most likely to be offered an intervention. Medication was the most commonly offered intervention and 39.3% of those who tried medication found this helpful. Although offered less often, approximately half of the men who tried devices or attended specialist services found the intervention helpful. Free-text responses indicated that barriers to accessing support included inadequate information and support from healthcare professionals, embarrassment, negative views about treatment options, concerns about side effects and safety, and inconsistencies between secondary and primary care. Barriers to continuing use included limited effectiveness of treatments, inadequate ongoing support, and funding constraints. Drivers of sexual recovery included patient proactivity and persistence with trying different treatment options and ongoing support from health professionals.

CLINICAL IMPLICATIONS

There is an urgent need to ensure that all men are offered, and have equal access to, sexual care support, with referral to specialist services when required.

STRENGTHS & LIMITATIONS

This study presents data from a large, U.K.-wide, population-based study of men with PCa and includes quantitative and qualitative findings. The possibility of non-response bias should, however, be considered.

CONCLUSION

There are significant shortcomings in the support offered to U.K. men with sexual dysfunction following diagnosis and treatment for PCa which need to be addressed. Watson E, Wilding S, Matheson L, et al. Experiences of Support for Sexual Dysfunction in Men With Prostate Cancer: Findings From a U.K.-Wide Mixed Methods Study. J Sex Med 2021;18:515-525.