Erectile dysfunction after surgical treatment

An online Sexual Health and Rehabilitation eClinic (TrueNTH SHAReClinic) for prostate cancer patients: a feasibility study

Purpose

The primary objective was to determine the feasibility of implementing the TrueNTH SHAReClinic as a pan-Canadian sexual health and rehabilitation intervention for patients treated for localized prostate cancer.

Methods

The feasibility study was designed to evaluate the accessibility and acceptability of the intervention. Participants from five institutions across Canada were enrolled to attend one pre-treatment and five follow-up online clinic visits over 1 year following their prostate cancer (PC) treatment.

Results

Sixty-five patients were enrolled in the intervention. Website analytics revealed that 71% completed the intervention in its entirety, including the educational modules, with an additional 10% completing more than half of the intervention. Five thousand eighty-three views of the educational modules were made along with 654 views of the health library items. Over 1500 messages were exchanged between participants and their sexual health coaches. At 12 months, the intervention received an overall average participant rating of 4.1 out of 5 on a single item satisfaction measure.

Conclusion

Results support the TrueNTH SHAReClinic as highly acceptable to participants as defined by intervention adherence and engagement. The TrueNTH SHAReClinic demonstrated promise for being a feasible and potentially resource-efficient approach to effectively improving the sexual well-being of patients after PC treatment.

Erectile Dysfunction and Correlates Among Diabetic Men at Dessie Referral Hospital: North Central Ethiopia, 2020

BACKGROUND

Erectile dysfunction is currently one of the most common sexual dysfunctions worldwide affecting the quality of life of men of all ages, but it is usually underestimated because it is not a life threatening condition.

PURPOSE

This study aims to determine the prevalence of erectile dysfunction and the possible correlates among diabetic men in Dessie Referral Hospital, North Central Ethiopia.

METHODS

An institution-based cross-sectional study was conducted among diabetic men aged greater than 18 years, at Dessie Referral Hospital. Systematic random sampling technique was used to select study participants. A pre-tested and structured questionnaire was used to collect the data. Data were entered in Epi Info version 7 and analyzed using SPSS version 21. Logistic regression was applied to identify association between explanatory variables and the outcome variable. An adjusted odds ratio with 95% confidence interval and p-value less than 0.05 was computed to determine the level of significance.

RESULTS

Overall, the prevalence of erectile dysfunction (ED) in this study was 58.5% at 95% CI (0.548-0.622), and specifically 10.5%, 40.9%, 6.8% respondents had mild, moderate and severe erectile dysfunction, respectively. Age, duration of diabetes diagnosis, types of medication, types of complication and body mass index were significant unadjusted factors associated with erectile dysfunction, but following adjustment only age [AOR=5.5 (95% CI 2.06-14.744), duration of diabetes [AOR=20,(95% CI 5.663-75.0096) and types of medication [AOR=2.106 (95% CI 1.112-3.988) have independently statistically significant association with erectile dysfunction.

CONCLUSION

This study showed that ED is high. Age, duration of diabetes mellitus and type of medication are independently associated with erectile dysfunction. Health policymakers need to consider including the training of health personnel to consider the relevant risk factors during the physical, social and psychological assessment of patients, and clinicians should pay attention to the sexual history of their client.

Results of unilateral genitofemoral nerve grafts with contralateral nerve sparing during radical prostatectomy

OBJECTIVES

To evaluate the success of erectile function preservation and recovery in a select group of patients with extensive disease unilaterally on biopsy who were candidates for unilateral nerve sparing and contralateral genitofemoral interposition nerve-grafting radical prostatectomy (RP). Because of its low donor site morbidity, the genitofemoral nerve is an appealing donor source for cavernous nerve grafting during RP. Although evidence has shown that sural interposition nerve grafts during RP preserve erectile function, the evidence for genitofemoral nerve grafts is limited.

METHODS

Nerve-sparing RP was performed according to the technique of Walsh on 22 patients with prostate cancer. At follow-up, the patients completed an 11-item self-report questionnaire that included the erectile function (EF) domain of the International Index of Erectile Function.

RESULTS

The mean patient age was 62 years (range 48 to 76). The mean follow-up time was 23 months (range 9 to 37). Of the 22 patients, 3 reported no erectile dysfunction (ED) (EF score 26 to 30), 3 reported mild ED (EF score 22 to 25), 1 reported moderate ED (EF score 11 to 16), and 15 reported severe ED (EF score less than 11). Eight men continued to experience mild chronic thigh or scrotal numbness after the genitofemoral nerve graft procedure.

CONCLUSIONS

The benefits of unilateral nerve grafting with the genitofemoral nerve remain uncertain. A prospective randomized trial is warranted before the widespread adoption of unilateral nerve grafting.

Prostate Cancer Survivors' and Partners' Self-Reports of Health-Related Quality of Life, Treatment Symptoms, and Marital Satisfaction 2.5-5.5 Years After Treatment

PURPOSE/OBJECTIVES

To describe health-related quality of life (QOL), health status, and marital satisfaction of couples as many as 5.5 years after treatment for prostate cancer.

DESIGN

Survey with longitudinal, comparative, and predictive elements.

SETTING

A tertiary care nonprofit medical center in the southwestern United States.

SAMPLE

Convenience sample of prostate cancer survivors (192 enrolled, 137 completed) and their partners (126 enrolled, 104 completed). Men averaged 70 years of age, women 66. Most men (86%) and women (89%) were white, and 71% had at least some college education.

METHODS

Questionnaires were mailed annually. Women were enrolled 3.5 years after their partners were treated. Study participants received separate questionnaire packets.

MAIN RESEARCH VARIABLES

Health-related QOL, health status including post-treatment symptoms, and marital satisfaction.

FINDINGS

Men's health-related QOL, general physical health, and vitality decreased; urinary and sexual post-treatment symptoms increased. Men were concerned about their sexual functioning although few sought treatment. Couples' health-related QOL and marital satisfaction were associated more closely than their health status.

CONCLUSIONS

Regardless of type of treatment, health-related QOL and general health tend to decrease for prostate cancer survivors; men in watchful waiting tended to have poorer health outcomes. Men are concerned about sexual functioning, yet few are taking steps to remedy problems. Couples' health-related QOL and marital satisfaction are linked; however, health status indicators are less associated.

IMPLICATIONS FOR NURSING

Nurses are in a key position to assess health-related QOL and sexual functioning concerns for prostate cancer survivors and their partners.

Couples Surviving Prostate Cancer: Long-Term Intimacy Needs and Concerns Following Treatment

Couples surviving prostate cancer face long-term challenges in their relationships as they adapt to chronic illness. Ten couples surviving prostate cancer were brought together in a focus group to discuss their experiences and concerns regarding intimacy in their relationships. During three 30-minute segments, couples described their experiences (a) as couples, (b) as individual men and women in two concurrent break-out groups, and (c) regarding current intimacy and relationship needs. Questions asked of couples focused on (a) the process of being diagnosed and treated for prostate cancer, (b) what the experience was like for them as a couple, (c) what was helpful, harmful, and surprising throughout the experience, (d) what they currently needed most as a couple, and (e) what advice they had for other couples. Findings suggested that men and women think and respond differently to intimacy and relationship challenges that occur as a result of prostate cancer, diagnosis, and treatment. Consequently, healthcare providers in any clinical setting who may interact with prostate cancer survivors must consider the relationship and intimacy needs that are unique to men, women, and couples.

Recovery issues in cancer survivorship: a new challenge for supportive care

The growing population of cancer survivors represents a clear challenge to clinicians and researchers to look beyond the search for a cure and to address the multifaceted needs of those living with and beyond a cancer diagnosis. Common sequelae that disrupt the psychosocial aspects of life for adult cancer survivors after primary treatment include: fatigue; cognitive changes; body image; sexual health and functioning; infertility; fear of recurrence; PTSD and stress syndromes; family/caregiver distress; socioeconomic issues; and distress, anxiety, and depression. Psychosocial interventions, particularly group-based interventions and physical activity programs, have shown great promise in improving these outcomes. Future research will identify even better targeted, more efficacious, and more cost effective programs and disseminate them into cancer care settings. Healthcare providers must realize that they serve as vital gatekeepers to services that will help optimize cancer survivors' psychosocial as well as physical outcomes. Addressing these issues in the post-treatment period represents the new challenge to supportive care.

The effects of cancer and cancer treatments on male reproductive function

In male cancer patients, surgery, radiotherapy and chemotherapy can be followed by transient or permanent infertility by affecting ejaculatory or erectile function, or by impairing spermatogenesis. Cancer specialists should, therefore, discuss the impact of different therapies on fertility with their patients prior to treatment, and consider fertility-preserving measures before and during treatment, such as nerve-sparing operative techniques, adequate testicular shielding during radiotherapy and the avoidance of unnecessary gonadotoxic chemotherapy. Pretreatment sperm-cell cryopreservation should be offered, even in cases where the individual's risk of post-treatment infertility might seem minimal or if it might require testicular sperm-cell extraction. Samples that are severely oligospermic should also be cryopreserved. Post-treatment ejaculatory or erectile dysfunction can be reversed pharmacologically, but the success rate varies with the extent of neurologic sequelae of the treatments used. At present there is no established method to stimulate post-treatment impaired spermatogenesis, although currently available assisted reproductive techniques overcome some of the existing problems of infertility in cancer survivors, and ongoing research will hopefully increase these possibilities. A multidisciplinary approach that depends on close cooperation between relevant medical specialists is central to achieving such advances.

SEXUAL DYSFUNCTION AFTER RADICAL PROSTATECTOMY: PREVALENCE, TREATMENTS, RESTRICTED USE OF TREATMENTS AND DISTRESS

PURPOSE

Cancer of the prostate (CAP) is one of the most common malignancies affecting North American men with about 215,000 new cases and 35,800 CAP related deaths annually. The most prevalent intervention for localized CAP is radical prostatectomy (RP) with 10-year survival rates approaching 90%. Studies of men in post-RP recovery indicate that 44% to 75% experience sexual dysfunction and more than 60% experience distress in reaction to sexual dysfunction problems. These findings are increasingly significant as prostate specific antigen testing continues to increase CAP detection rates, resulting in more and younger post-RP patients confronting sexual dysfunction.

MATERIALS AND METHODS

A MEDLINE database search was performed for articles published from 1966 to September 2004.

RESULTS

Despite effectiveness 30% to 50% of patients who turn to sexually assistive aids after RP discontinue use within a year. This suggests that the achievement of physical responsiveness to an aid is necessary but it is not a sufficient factor in long-term sexual adaptation. Current research exploring this gap between effectiveness and ongoing use supports a broader perspective of sexual dysfunction emphasizing several factors, including perceptions of inadequacy, anxieties in regard to performance and depression in each member of the couple, overly enthusiastic expectations, partner physical/emotional readiness to resume active sex, the meaning to the couple of using a sexual aid and the quality of the nonsexual relationship of the couple.

CONCLUSIONS

Our findings reveal the need to explore broader strategies for improving patient coping ability and adaptation. They also point to the need to explore the role of resumed satisfying sexuality in overall quality of life following treatment.