Zusammenfassung
Die erektile Funktion ist für den Mann bezüglich der Lebensqualität und Lebensfreude essentiell. Die postoperative erektile Dysfunktion (ED) nach radikaler Prostatektomie (RPE) stellt neben der Inkontinenz eines der wichtigsten Probleme dar. Als erste Anlaufstation ist die Beratung durch die Rehabilitationsklinik gefordert.
Bei 149 Patienten nach RPE erfolgte eine prospektive Befragung bzgl. des Kenntnisstandes zur postoperativen ED nach RPE und der psychischen Belastung sowie zu den möglichen Therapieoptionen. Die Qualität der präoperativen Patientenaufklärung und der Informationsmodule zur ED während der Rehabilitation wurden bewertet. Eine wesentliche Belastung durch die postoperative ED äußerten 53% der Patienten während der Anschlussrehabilitation (AR-Gruppe) und 70% der Patienten während eines onkologischen Heilverfahrens (Reha-Gruppe). Präoperativ sexuell aktivere Männer litten stärker unter der postoperativen ED. Es bestand in der AR-Gruppe eine negative Korrelation zwischen psychischer Belastung und Lebensalter, die in der Reha-Gruppe nivelliert war. Mit zunehmendem Abstand zur Operation wurde der Leidensdruck bezüglich der ED insbesondere bei den älteren Patienten größer. Die im Rahmen der stationären Rehabilitation durchgeführte Wissensvermittlung zu den Therapieoptionen der ED wurde von 60% der AR-Gruppe und 48% der Reha-Gruppe als wesentlich bewertet.
Therapeutische Möglichkeiten der postoperativen ED nach RPE können dem Patienten in der Vorbereitungsphase zur Operation und während des Aufenthalts in der Akutklinik nicht immer umfassend vermittelt werden. Da jedoch überwiegend ein großer Leidensdruck besteht, eignet sich die stationäre fachspezifische urologische Rehabilitation in besonderer Weise zur umfassenden Beratung des Patienten zur ED nach RPE.
Abstract
For men erectile function is essential for quality of life. Besides urine incontinence postsurgical erectile dysfunction (ED) following radical prostatectomy (RPE) represents a significant and prevalent problem. One of the first approaches to this condition should be a consultation performed by professionals in a rehabilitation clinic.
A total of 149 patients post RPE participated in this prospective study. All patients were questioned about their understanding of postoperative surgical ED after RPE and if affected they were asked about their own psychological burden as well as their knowledge of possible therapy options. The qualities of presurgical patient information as well as the modules of information pertaining to ED during the rehabilitation were evaluated. Of the patients, 53% expressed that they experienced a considerable burden due to postsurgical ED during their follow-up rehabilitation (AR group) and 70% of the patients during oncological rehabilitation treatment (rehab group). Men who were sexually more active prior to surgery suffered more from postsurgical ED than their less active counterparts. A negative correlation between psychological burden and age was found in the AR group, which however was levelled in the rehab group. Particularly in older patients the burden of ED increases with more time elapsing after the operation. The medical information on ED therapy options provided during the inpatient rehabilitation was considered to be essential by 60% of the men in the AR group and 48% of the patients in the rehab group.
Therapeutic possibilities for postsurgical ED following RPE cannot always be given to patients in the preoperative phase or during their stay in the hospital. Since however a large majority of men suffer from postoperative ED following RPE a specialized inpatient urological rehabilitation is suited for a comprehensive consultation.
Literatur
Bannowsky A, Schulze H, Horst C van der, Jünemann KP (2010) Nervenerhaltende radikale Prostatektomie mit niedrig dosiertem Sildenafil. Urologe 49/12:1516–1521
Braun M, Wassmer G, Klotz T et al (2000) Epidemiology of erectile dysfunction: results of the ‚Cologne Male Survey’. Int J Impot Res 12(6):305–311
Burnett AL (2003) Strategies to promote recovery of cavernous nerve function after radical prostatectomy. World J Urol 20(6):337–342
Gontero P, Fontana F, Zitella A et al (2005) A prospective evaluation of efficacy and compliance with a multistep treatment approach for erectile dysfunction in patients after non-nerve sparing radical prostatectomy. BJU Int 95(3):359–365
Kirschner-Hermanns R, Jakse G, Heathcote PS et al (1998) Health-related quality of life in Australian men remaining disease-free after radical prostatectomy. Med J Austral 168(10):483–486
Kirschner-Hermanns R, Jakse G (2002) Quality of life following radical prostatectomy. Crit Rev Oncol Hematol 43(2):141–151
Köhler TS, Pedro R, Hendlin K et al (2007) A pilot study on the early use of the vacuum erection device after radical retropubic prostatectomy. BJU Int 100(4):858–862
Mathers MJ, Klotz T, Brandt AS et al (2008a) Long-term treatment of erectile dysfunction with a phosphodiesterase-5 inhibitor and dose optimization based on nocturnal penile tumescence. BJU Int 101(9):1129–1134
Mathers MJ, Klotz T, Vahlensieck W et al (2008b) Ist eine Rehabilitation der erektilen Funktion nach beckenchirurgischen Eingriffen sinnvoll? Urologe 47(6):685–692
McCullough AR, Hellstrom WG, Wang R et al (2010) Recovery of erectile function after nerve sparing radical prostatectomy and penile rehabilitation with nightly intraurethral Alprostadil versus Sildenafil citrate. J Urol 183(6):2451–2456
Meyer JP, Gillatt DA, Lockyer R, Macdonagh R (2003) The effect of erectile dysfunction on the quality of life of men after radical prostatectomy. BJU Int 92(9):929–931
Miles CL, Candy B, Jones L et al (2007) Interventions for sexual dysfunction following treatments for cancer. Cochrane Database Syst Rev 4, CD005540
Montorsi F, Maga T, Strambi LF et al (2000) Sildenafil taken at bedtime significantly increases nocturnal erections: results of a placebo-controlled study. Urology 56(6):906–911
Montorsi F, Brock G, Lee J et al (2008) Effect of nightly versus on-demand vardenafil on recovery of erectile function in men following bilateral nerve-sparing radical prostatectomv. Eur Urol 54(4):924–931
Mulhall JP, Parker M, Waters BW, Flanigan R (2010) The timing of penile rehabilitation after bilateral nerve-sparing radical prostatectomy affects the recovery of erectile function. BJU Int 105(1):37–41
Noldus J, Michl U, Graefen M et al (2002) Patient-reported sexual function after nerve-sparing radical retropubic prostatectomy. Eur Urol 42(2):118–124
Padma-Nathan H, McCullough AR, Levine LA et al (2008) Randomized, double-blind, placebo-controlled study of postoperative nightly sildenafil citrate for the prevention of erectile dysfunction after bilateral nerve-sparing radical prostatectomy. Intern J Impotence Res 20/5:479–486
Papadoukakis S, Kusche D, Ohm N et al (2006) Einschränkungen bei dem Einsatz des IIEF Fragebogens bei Patienten mit Prostatamalignom zur Potenzevaluation vor radikaler Prostatektomie. Urology 45(Suppl 1):136
Quinlan DM, Epstein JI, Carter BS, Walsh PC (1991) Sexual function following radical prostatectomy: influence of preservation of neurovascular bundles. J Urol 145(5):998–1002
Rabbani F, Stapleton AM, Kattan MW et al (2000) Factors predicting recovery of erections after radical prostatectomy. J Urol 164(6):1929–1934
Sommer F (2003) Continuous once a day treatment with Sildenafil: daily sex prevents the „aging penis“ MMW Fortschr Med 145(1)9:59
Sommer F (2006) Rehabilitation/Präservation der erektilen Funktion nach radikaler Prostatektomie. URO-NEWS 2006(1):48–55
Sommer F (2009) Das Schweigen der Männer. URO-NEWS 11:3
Trinchieri A, Nicola M, Masini F, Mangiarotti B (2005) Prospective comprehensive assessment of sexual function after retropubic non nerve sparing radical prostatectomy for localized prostate cancer. Archivio italiano di urologia, Andrologia 77(4):219–223
Walsh PC, Marschke P, Ricker D, Burnett AL (2000) Patient-reported urinary continence and sexual function after anatomic radical prostatectomy. Urology 55(1):58–61
Zucchi A, Mearini L, Costantini E et al (2006) Sexual Rehabilitation after radical retropubic prostatectomy: a randomised prospective study on vacuum device + Sildenafil vs. Alprostadil + Sildenafil. Eur Urol 2(Suppl 5):142
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Vahlensieck, W., Sommer, F., Mathers, M. et al. Beratung zur erektilen Dysfunktion während stationärer Rehabilitation nach radikaler Prostatektomie. Urologe 50, 417–424 (2011). https://doi.org/10.1007/s00120-010-2476-4
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DOI: https://doi.org/10.1007/s00120-010-2476-4