Erectile dysfunction following retropubic prostatectomy

Prostate cancer is the most common cancer to affect men in the UK. Treatment options depend on the grade of tumour, the patient's co-existing diseases and choice of treatment. One potentially curative option is surgery, specifically a radical retropubic prostatectomy or variation thereof. As a consequence of the surgery, men commonly experience two side-effects: urinary incontinence and erectile dysfunction (ED). This paper outlines the clinical management of ED following surgery and aims to provide an overview of how to assess a man who has developed ED and discuss the various treatment options available, along with the efficacy in terms of recovery of erections.

Breaking the silence: helping men with erectile dysfunction

Erectile dysfunction is a condition that is often under-reported. This article provides the community nurse with a brief overview of erectile dysfunction in the context of sexual health and its importance to wellbeing. The article outlines issues concerning epidemiology, the possible causes of erectile dysfunction and the impact the condition can have on the man's quality of life. Often men with erectile dysfunction report being stigmatised, feeling shame and experiencing guilt. The role of the community nurse in assessing, making a diagnosis and helping the man with the condition is described. The article emphasises the fact that in order to offer care effectively and competently the community nurse must be up to date and knowledgeable concerning the condition.

A sensitive subject

Nurses need to take the initiative in identifying erectile dysfunction. This common condition can be a marker for underlying conditions.

Sexuality and prostatectomy: nursing assessment and intervention

Erectile dysfunction is a known adverse effect associated with prostate cancer treatment. Established nursing interventions can positively affect the sexual functioning of these individuals and improve their quality of life.

Erectile dysfunction: physiology, causes and patient management

This article examines the prevalence, causes, identification, assessment and treatment options for men with erectile dysfunction. Erectile dysfunction is thought to affect one in ten men across the UK and is often a consequence of pathology and/or pharmacology. Treatment can be offered to all patients, but the keys to management are identification, accurate assessment and focused therapy. Nurses are well placed to identify and support men who have this distressing problem.

Psychosocial and relationship issues in men with erectile dysfunction

Erectile dysfunction (ED) affects approximately 30 million American men and is an issue that should not be ignored. Understanding the psychosocial as well as the functional effects of ED is important for clinicians in their practice. Obtaining a sexual history is now recommended as part of a routine assessment. It is important to understand how ED affects men, their partners, and their lives and how clinicians can therapeutically intervene.

Intracavernosal injection algorithm

Intracavernosal injections provide an effective therapy for men with erectile dysfunction who can not take oral agents or for whom oral agents are not effective. Determining the best initial dosage can be a challenge for health care providers. A literature review and 13 years of experience working with patients receiving intracavernosal injections provide the basis for the algorithm designed to provide guidance with the dosage and titration of the injection medications.

Nursing considerations in brachytherapy-related erectile dysfunction

Following definitive local treatment for early-stage prostate cancer, preservation of erectile function has been assumed to be most likely following brachytherapy. However, recent studies have demonstrated that brachytherapy-related erectile dysfunction (ED) is more common than initially reported. The exacerbation of brachytherapy-related ED is closely related to several clinical, treatment, and dosimetric parameters including pre-implant erectile function and radiation dose to the proximal penis. The majority of patients with brachytherapy-induced ED respond favorably to oral erectogenic agents.

Lumbar burst fracture associated with bowel, bladder, and sexual dysfunction: case study

Lumbar burst fractures occur when unusual force and flexion are placed on the spine, causing the vertebral body to rupture and possibly protrude into the spinal canal. A resulting conus medullaris injury is possible, but not common. In this case presentation, a young man suffered bowel, bladder, and sexual dysfunction after a 25-foot fall that caused a burst fracture of the first lumbar vertebra. The presentation's primary focus is the nursing education needed to care for patients who experience the unusual side effect of conus medullaris injury. The psychosocial aspects attributable to age, developmental stage, and stigma for a young man with these dysfunctions also are explored.

Assessing patients with actual or potential erectile dysfunction

Asking question about sexuality forms part of the nursing assessment but is often overlooked because of the embarrassment of both nurse and patient. However, failure to identify erection problems, either actual or potential, can result in distress, making eventual treatment more difficult. A prompt assessment and referral to an erectile dysfunction clinic are required.

Nursing assessment of sexual function following permanent prostate brachytherapy for patients with early-stage prostate cancer

Assessment of sexual function following potentially curative local treatment for carcinoma of the prostate gland has resulted in wide ranges of potency preservation rates, which may be because of differences in the evaluated patient populations, mode of data collection, and length of patient follow-up. Quality-of-life data are most reliable when obtained by patient-administered and validated quality-of-life instruments. In the Schiffler Cancer Center's prostate brachytherapy unit, healthcare professionals utilize the specific erectile questions of the International Index of Erectile Function to ascertain pre- and post-treatment erectile function. Documentation of sexual function following all local treatments, including prostate brachytherapy, may help to clarify the etiology of treatment-induced erectile dysfunction (ED), improve treatment for ED, and, ultimately, improve quality-of-life outcomes. Fortunately, the majority of patients with brachytherapy-induced ED respond favorably to sildenafil citrate.

Investigating the effect of erectile dysfunction on the lives of men: a qualitative research study

1. The aim of this project was to identify and explore the issues facing men who live with erectile dysfunction (ED), in particular men's' relationships with women partners and men's interactions with the wider world. 2. In order to gain an understanding of their everyday lives, a qualitative research design was used. This is an account of the interpretation and analysis of nine interviews with men living with ED that were carried out during the autumn of 1997. 3. The analysis identified two main themes, 'loss' and 'being alone with it'; with meta-categories 'making sense of it' and 'telling other people', and 'place of sex'. The latter acts as a bridge between the two themes. 4. The implications for nursing practice are considered and recommendations are made for practice, education and research.

Outcome measures for erectile dysfunction 2: evaluation

This article, the second of two parts, discusses and evaluates the range of outcome measures for erectile dysfunction (ED) identified from the literature review in part one (Vol 11(1): 54-64). The literature review identified 14 subjective and 12 objective measures. These outcome measures are needed for the components: rigidity, vascular flow, nerve conductivity, intracavernosus muscle power, partner satisfaction and quality of life. Instruments selected should provide good validity, reliability and responsiveness. Quick, simple, inexpensive and efficient outcome measures can be used by nurses.

Outcome measures for erectile dysfunction. 1: Literature review

This article describes and evaluates critically the outcome measures available for the assessment of the conservative treatment of erectile dysfunction (ED). The literature review identified 26 outcome measures. Of these, 14 were subjective and 12 were objective. Objective measures can provide more accurate information. However, owing to the sensitive nature of the problem, questionnaires which are reliable and sensitive to change can provide valuable data. Different outcome measures were needed for each of the separate components of ED. These components were found to be rigidity, vascular flow, nerve conductivity, intracavemosal pressure, ischiocavernosus muscle power, partner satisfaction and quality of life. An evaluation of outcome measures for each component of ED is provided in the second part of this article. Quick, simple, inexpensive and efficient outcome measures can be used by nurses to evaluate the impact of conservative treatment for ED.

The problem of erectile dysfunction following myocardial infarction

The causes of erection problems after an MI can be physical, psychological, a result of medication or a combination of these factors. This paper examines the causes and considers ways in which nurses can help men experiencing this problem, who may still feel embarrassed to broach this subject even though it is now more publically discussed.

Mastery of postprostatectomy incontinence and impotence: his work, her work, our work

PURPOSE/OBJECTIVES

To describe couples' experiences of postprostatectomy incontinence and impotence.

DESIGN

Descriptive, qualitative.

SETTING

Northeastern U.S. metropolitan area.

SAMPLE

Subsample of 20 (10 control and 10 intervention) couples from a large quantitative clinical trial of a Standardized Nursing Intervention Protocol (SNIP) postprostatectomy.

METHODS

Interviews were conducted using a semistructured guide. Data were analyzed using grounded theory techniques.

MAIN RESEARCH VARIABLE

Couples' experiences of coping with postprostatectomy incontinence and impotence.

FINDINGS

Managing postprostatectomy incontinence and impotence required work. Men's work focused on regaining mastery and encompassed understanding incontinence as healing, mastering incontinence, networking, confronting impotence and putting it into perspective, and prioritizing. Wives were supportive by managing anxiety, encouraging mastery, putting impotence into perspective, and reassuring their spouses. Established routines brought couples through the experience together while strengthening intimacy. SNIP couples found the nurses to be sources of information, support, and affirmation.

CONCLUSIONS

Couples worked to deal with postprostatectomy incontinence and impotence within the context of surviving cancer and maintaining a loving relationship. This gave unique meaning to their symptoms and led the couples to value the fact that the men were alive and work toward regaining mastery. Mastery emerged as a key concept from the findings.

IMPLICATIONS FOR NURSING PRACTICE

Nurses can gain from an enhanced understanding of postprostatectomy incontinence and impotence as meaningful within the greater context of patients having had cancer. Nurses can hasten couples' abilities to regain a sense of mastery by providing information, supporting couples' work, providing positive affirmation, and being available.

Providing nursing care for erectile dysfunction

Erectile dysfunction may affect one in 10 men as they age. The publicity surrounding the introduction of Viagra has led to more men coming forward for treatment for ED. Specialist urology nurses have the communication and counselling skills necessary to provide quality care to this patient group.

The role of the NP in the diagnosis and management of erectile dysfunction

Erectile dysfunction (ED) affects approximately 30 million men, significantly affecting their quality of life and relationships. More and more men are seeking help for this problem due to the advent of simpler, less-invasive treatment options. Inevitably, nurse practitioners (NPs) in primary care will encounter patients with ED. The assessment and diagnosis of ED can be facilitated by using a structured decision-making approach, which will promote comprehensive patient care. Some primary care NPs may need to increase their own comfort level with taking a sexual history, evaluating sexual problems, and knowing when to refer to a specialist.

The challenges of diagnosing erectile dysfunction in the primary care setting

Erectile dysfunction is present in approximately half of all men between the ages of 40 and 70. Patients are often reluctant to discuss this problem with their practitioner; therefore, unless the practitioner is able to initiate the discussion, the diagnosis will not be made and successful treatment will not be started. Primary care practitioners have previously received little training in taking the sexual history of their patients. In addition, primary care practitioners are under increasing pressure to see more and more patients in less and less time. Erectile dysfunction is a condition that is relatively easy to diagnose using history, physical examination, and laboratory tests at the disposal of the primary care practitioner. Although referral to an urologist may be necessary, most patients can be successfully treated in the primary care setting.

The patient with erectile dysfunction: psychological issues

Erectile dysfunction (ED) affects as many as 30 million men and their partners in the United States. Although clinicians now recognize that as many as 80% of cases of ED are organic in origin, psychological issues remain important for the ED patient.

Diagnosis and treatment of erectile dysfunction: the process of care model

The new era of erectile dysfunction (ED) medicine ushered in by the availability of an effective and safe oral medication paves the way toward managing ED in a primary care setting. The Process of Care Model for the Evaluation and Treatment of Erectile Dysfunction was developed to advance new guidelines for the diagnosis and management of ED. This paper discusses these guidelines.

The Erectile Dysfunction Nurses Association (EDNA)

The Erectile Dysfunction Nurses Association (EDNA) launched its website this summer. This article describes the website and outlines how nurses can make best use of it.

Sexual dysfunction in men on chronic hemodialysis: a rehabilitation nursing concern

The rehabilitation potential of hemodialysis patients is hampered by the many complications associated with a uremic state and hemodialysis therapy. One complication that is particularly disturbing to male hemodialysis patients is sexual dysfunction, which affects about 50% of them and whose exact cause is unknown. This article reviews the literature regarding factors associated with sexual dysfunction in male patients on dialysis and the implications for rehabilitation nursing practice.

Impotence and perceived partner support

Because impotence has both physiologic and psychologic components, it seems that impotent patients might benefit from a holistic approach to treatment that includes a medical regimen for physiologic factors as well as treatment for social and psychologic factors. The spousal relationship is one social and/or psychological factor. Often, a male experiences his sexual dysfunction as profoundly stressful while the partner finds it annoying or disturbing, but not threatening to the overall bond between them (Rust, Golombok, & Collier, 1988). This study was conducted to explore patient perception of the spousal (partner) relationship during admission to an erectile dysfunction clinic.

Self-esteem and depression in men who present with erectile dysfunction

Erectile dysfunction always has a psychologic component in addition to the underlying physical cause. The extent of depression and reduced self-esteem in patients who present with erectile dysfunction are explored in this study. Suggestions are given for how urologic nurses can overcome patients' fears and concerns.

Viagra for home care patients

In March 1998 a totally new type of therapeutic agent, sildenafil citrate (Viagra), was approved by the Food and Drug Administration for marketing in the United States as an oral tablet for erectile dysfunction in men. Extensive media coverage may have overshadowed the actual value and potential limitations of this therapeutic agent. Because sildenafil is a prescription-only medication that may be used in ambulatory and home care patients, home caregivers need to understand its intended use, mechanism and dose, and potential problems that may occur in patients who receive it.