Despite surgical advancements, erectile dysfunction (ED) is a common consequence of radical prostatectomy (RP). This study aimed to evaluate the impact of early penile rehabilitation within a dedicated penile rehabilitation program on assisted and unassisted erectile function (EF) recovery. All patients who underwent RP and at least 1 year follow-up at penile rehabilitation program in the Department of Urology, OORR Policlinico Riuniti (Foggia, Italy) were included. Treatment involved phosphodiesterase type 5 inhibitors (PDE5Is; tadalafil 20 mg, 1 tablet every other day), intracavernous injections (Caverject 5 µg, 1 vial per week), and daily use of vacuum erection devices (VEDs). Primary end point was EF recovery defined as International Index of Erectile Function-5 (IIEF-5) ≥21 with or without rehabilitation aids. IIEF-5 and prescribed treatments were prospectively collected at 3 months, 6 months, 9 months, 12 months, and 24 months. Among 570 eligible patients, 397 (69.6%) underwent rehabilitation. Patients who undergoing andro-rehabilitation were younger (65 months vs 70 months; P < 0.0001), had lower prostate-specific antigen (PSA) levels (5.9 ng ml -1 vs 6.2 ng ml -1 ; P = 0.04), and lower grade tumors ( P = 0.001) compared to the patients who did not undergo sexual rehabilitation after radical prostatectomy. Two-year EF recovery rates in patients undergoing andro-rehabilitation ranged from 75% (preoperative IIEF-5 >16) to 45% (preoperative IIEF-5 <16) with rehabilitation aids. Combination treatments (PDE5I+VEDs with or without intracavernous injections) showed the highest rates of EF recovery (up to 80% at 2 years). EF recovery without rehabilitation aids was significantly higher for patients with IIEF-5 >21 (IIEF-5 >21 [36%] vs IIEF-5 of 17-21 [18%]; P = 0.01). Subanalysis indicated a moderate benefit of rehabilitation in patients with preoperative IIEF-5 <16 who underwent bilateral nerve-sparing RP. Participation in intensive penile rehabilitation programs improves EF recovery in patients undergoing RP. Preserving the neurovascular bundles may be beneficial for patients with preoperative ED.
Humans ; Male ; Prostatectomy/rehabilitation* ; Middle Aged ; Erectile Dysfunction/drug therapy* ; Aged ; Recovery of Function ; Robotic Surgical Procedures/adverse effects* ; Phosphodiesterase 5 Inhibitors/therapeutic use* ; Penile Erection ; Tadalafil/therapeutic use* ; Prostatic Neoplasms/surgery* ; Treatment Outcome

OBJECTIVE: To explore the improvement effect of rehabilitation nursing based on information-knowledge-belief-behavior (IKAP) theory on urinary incontinence patients after radical prostatectomy. METHODS Sixty-six patients with urinary incontinence who received robot-assisted laparoscopic radical prostatectomy in General Hospital of Eastern Theater Command from January 2021 to January 2023 were selected and divided into control group (n=33) and observation group (n=33) according to random number table method. The patients in the control group were treated with rehabilitation nursing. The patients in the observation group were treated with rehabilitation nursing guided by IKAP theory. The recovery of urinary incontinence, duration of urinary incontinence, subjective well-being, quality of life, psychological and emotional indexes of patients in the two groups were compared. Results： The total effective rate of urinary incontinence recovery in the observation group was significantly higher than that in the control group (90.91% vs 60.61%，P<0.05). The duration of urinary incontinence in the observation group was significantly shorter than that in the control group (［3.36±1.54］d vs ［4.15±1.36］d，P<0.05). And the subjective well-being score in observation group was significantly higher than that in the control group (［19.36±2.69］points vs ［11.65±2.65］points， P<0.05). There was no significant difference in preoperative physical function, social function，and mental health scores between the two groups (P>0.05). And all scores in the observation group were significantly higher than those in the control group after surgery (P<0.05). There was no significant difference in the preoperative SAS and SDS scores between the two groups of patients (P>0.05). And the scores of SAS and SDS in observation group were lower than those of the control group after the operation (P<0.05). Conclusion： Rehabilitation nursing based on IKAP theory can significantly improve urinary incontinence in patients with prostate cancer after surgery, which promotes the recovery of urinary incontinence, shortens the time of urinary incontinence, and improves the subjective well-being and quality of life, as well as reduces the negative impact of negative emotions. Therefore, it can be widely promoted and implemented in clinical practice.
Humans ; Prostatectomy/adverse effects* ; Urinary Incontinence/etiology* ; Male ; Quality of Life ; Rehabilitation Nursing ; Middle Aged ; Aged

Multimodal precision nursing intervention enhances cognitive function and quality of life through multisensory collaborative stimulation by integrating multidimensional data of patients. As one of the most common complications after radical prostatectomy, urinary incontinence seriously affects the quality of life of prostate cancer patients after surgery which has a negative impact on multidimensional health in the "physiological-psychological-social" aspects. This paper summarizes the clinical manifestations, influencing factors, and nursing interventions of urinary incontinence after radical prostatectomy, and focuses on the key points of nursing based on multimodal theory, in order to provide nursing strategies for improving urinary incontinence after prostate cancer surgery.
Humans ; Urinary Incontinence/etiology* ; Prostatectomy/rehabilitation* ; Male ; Prostatic Neoplasms/surgery* ; Quality of Life ; Postoperative Complications/nursing*

Vacuum erection device (VED), used to treat radical prostatectomy (RP)-associated erectile dysfunction, has attracted considerable attention. However, the optimal negative pressure remains to be determined. This investigation explored the optimal pressure for VED therapy in penile rehabilitation. Thirty-six 9-week-old male rats were randomly divided into six groups: control groups (sham group, bilateral cavernous nerve crush [BCNC] group) and VED therapy groups (-200 mmHg group, -300 mmHg group, -400 mmHg group, -500 mmHg group). BCNC group and VED therapy groups underwent BCNC surgery. Intracavernosal pressure (ICP)/mean arterial pressure (MAP) ratio was calculated to assess erectile function. Masson's trichrome (MT) staining, terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay, immunohistochemistry, and real-time polymerase chain reaction (RT-PCR) were performed to explore cellular and molecular changes of the penis. Compared to the BCNC group, ICP/MAP ratios in all VED treatment groups were improved significantly (all P < 0.05), but there were no statistically significant differences among VED therapy groups. With increased pressure, complications gradually emerged and increased in frequency. Expression of molecular indicators, such as endothelial nitric oxide synthase (eNOS) and alpha-smooth muscle actin (α-SMA), increased after VED therapy, and hypoxia-inducible factor 1α (HIF-1α) and transforming growth factor beta (TGF-β) decreased. In addition, VED therapy improved the outcomes of MT and TUNEL assay. This investigation demonstrated a pressure of -200 mmHg in a rat model is optimal for VED therapy for penile rehabilitation after RP. No further benefits were observed with increased pressure, despite an increase in complications.
Animals ; Disease Models, Animal ; Erectile Dysfunction/therapy* ; Male ; Penile Erection ; Penis/pathology* ; Pressure ; Prostatectomy/rehabilitation* ; Rats ; Rats, Sprague-Dawley ; Vacuum

PURPOSE: There are many grey areas in the field of penile rehabilitation after radical prostatectomy (RP). The preservation of the full dimensions of the penis is an important consideration for improving patients' compliance for the treatment. We present the first case series of patients treated by laparoscopic extraperitoneal RP and simultaneous penile prosthesis implantation (PPI) in order to preserve the full length of the penis and to improve patients' satisfaction. MATERIALS AND METHODS: From June 2013 to June 2014, 10 patients underwent simultaneous PPI (with an AMS InhibiZone prosthesis) and RP. Patients were evaluated by means of urological visits, questionnaires, and objective measurements before surgery, at discharge from the hospital, on postoperative days 21 to 28, each 3 months for the first year, and each 6 months thereafter. The main outcome measures were biochemical recurrence-free rate, penile length, and quality of life. RESULTS: Ten patients (mean age of 61 years; completed the study follow-up period (median, 32.2 months). No difference was found between the time of surgery and the 2-year follow-up evaluation in terms of penile length. The pre-surgery 36-Item Short Form Health Survey (SF-36) median score was 97. Patients were satisfied with their penile implants, and couples' level of sexual satisfaction was rated median 8. The median postoperative SF-36 score was 99 at 3 months follow-up. CONCLUSIONS: Laparoscopic extraperitoneal RP surgery with simultaneous PPI placement seems to be an interesting possibility to propose to motivated patients for preserving the length of the penis and improving their satisfaction.
Compliance ; Erectile Dysfunction ; Follow-Up Studies ; Health Surveys ; Humans ; Male ; Orgasm ; Outcome Assessment (Health Care) ; Penile Implantation ; Penile Prosthesis* ; Penis ; Prostatectomy* ; Prostatic Neoplasms ; Quality of Life ; Rehabilitation

PURPOSE: Climacturia is involuntary loss of urine during orgasm. The mechanism of climacturia in men who undergo radical prostatectomy (RP) is not fully understood, while deficiency in bladder neck coaptation during orgasm may be the cause. We evaluated the prevalence and risk factors of climacturia after RP. MATERIALS AND METHODS: We retrospectively reviewed the medical records of prostate cancer patients who underwent RP from 2002 to 2013 and was able to have a vaginal intercourse postoperatively. RP was conducted using open or robot-assisted approach. We analysed the symptoms of climacturia, relationship between climacturia and several clinical factors. Also, we tried to find factors to predict the presence of climacturia. RESULTS: Total of 123 patients were analyzed in this study. The median age of the men was 65 year and postoperative follow-up period for the interview was 37 months. Of the total 123 patients, 29 (23.6%) complained of the climacturia. In climacturia group, robot-assisted RP (p=0.018), nerve-sparing (p=0.046) and penile rehabilitation (p=0.012) were significantly less frequent, and more pad were comsumed (p=0.001) compared to non-climacturia group. On multivariable analysis, post-prostatectomy incontinence (PPI) (OR 6.49, p=0.004) and penile rehabilitation (OR 0.22, p=0.036) were significant factors to predict the presence of climacturia. CONCLUSIONS: Climacturia occurs in more than 20% patients who were potent enough after RP in our study. PPI and penile rehabilitation were positive and negative factor to predict an occurrence of climacturia, respectively. Therefore, in addition to PPI and erectile dysfunction, patients must be informed of this complication before undergoing RP.
Erectile Dysfunction ; Follow-Up Studies ; Humans ; Male ; Medical Records ; Neck ; Orgasm ; Prevalence ; Prostatectomy* ; Prostatic Neoplasms ; Rehabilitation ; Retrospective Studies ; Risk Factors ; Urinary Bladder ; Urinary Incontinence

Prostate cancer, bladder cancer, and rectal cancer are common malignancies in the male pelvis. The incidence rate of erectile dysfunction (ED) following radical prostatectomy, cystectomy or rectal cancer surgery is about 25% - 100%. The main cause of post-surgery ED is mainly attributed to injury of neurovascular bundles, which may lead to reduced oxygenation in and fibrosis of the penile tissue. Early penile rehabilitation after surgery can improve or restore the erectile function of the patients. This article focuses on penile rehabilitation after radical pelvic surgery.
Cystectomy ; Erectile Dysfunction ; etiology ; rehabilitation ; Humans ; Male ; Pelvic Neoplasms ; surgery ; Penile Erection ; Penis ; Postoperative Complications ; rehabilitation ; Postoperative Period ; Prostatectomy ; adverse effects ; Prostatic Neoplasms ; surgery ; Rectal Neoplasms ; surgery ; Urinary Bladder Neoplasms ; surgery

The vacuum erectile device (VED) uses negative pressure to increase blood inflow into the corpora cavernosum, with a ring at the base of the penis to maintain erection for intercourse or without a ring for penile rehabilitation. Owing to the limitation of phosphodiesterase 5 inhibitors (PDE5I) shown in the treatment of refractory erectile dysfunction (ED), the use of VED has resurged and is becoming the first line therapy in the treatment of ED following radical prostatectomy (RP). Currently, the combination therapy of VED with PDE5I and that of VED with intracavernous injection are advocated for post-RP ED. Hereby, we review the role of VED in penile rehabilitation, its underlying mechanisms, and the combination therapies for it.
Coitus ; Combined Modality Therapy ; methods ; Erectile Dysfunction ; drug therapy ; etiology ; rehabilitation ; Humans ; Male ; Penile Prosthesis ; Penis ; blood supply ; Phosphodiesterase 5 Inhibitors ; therapeutic use ; Prostatectomy ; adverse effects ; Regional Blood Flow ; Vacuum

Although disease-free survival remains the primary goal of prostate cancer treatment, erectile dysfunction (ED) remains a common complication that affects the quality of life. Even though several preventive and therapeutic strategies are available for ED after radical prostatectomy (RP), no specific recommendations have been made on the optimal rehabilitation or treatment strategy. Several treatment options are available, including phosphodiesterase-5 inhibitors, vacuum erection devices, intracavernosal or intraurethral prostaglandin injections, and penile prostheses. Urologists must consider more effective ways to establish optimal treatments for ED after RP. ED is an important issue among patients with prostate cancer, and many patients hope for early ED recovery after surgery. This review highlights the currently available treatment options for ED after RP and discusses the limitations of each.
Alprostadil/therapeutic use ; Erectile Dysfunction/etiology/*rehabilitation ; Humans ; Male ; Penile Implantation ; Phosphodiesterase 5 Inhibitors/therapeutic use ; Prostatectomy/*adverse effects/rehabilitation ; Prostatic Neoplasms/*surgery ; Risk Factors ; Vacuum ; Vasodilator Agents/therapeutic use

OBJECTIVETo investigate the efficacy and safety of vacuum erection device (VED) for erectile dysfunction (ED) after radical prostatectomy (RP).

METHODSSix cases of ED after open RP were reviewed. Three of the patients started a daily rehabilitation protocol using VED 10 min/d within 3 months after RP (group A, early intervention), while the other 3 initiated the same protocol after 12 months (group B, late intervention). We compared the IIEF-5 scores as well as stretched penile lengths and mid-shaft circumferences before and after 3 and 6 months of VED rehabilitation. We also assessed the safety of the device and sexual satisfaction of the patients and their partners.

RESULTSThe mean IIEF-5 score of the six cases was remarkably increased at 3 and 6 months of VED rehabilitation (P < 0.05), significantly higher in group A than in B at 3 months (8.7 +/- 0.6 vs 6.7 +/- 0.6, P < 0.05) and 6 months (13.0 +/- 1.0 vs 8.3 +/- 1.5, P < 0.05). After 6 months of VED rehabilitation, there were no significant changes in stretched penile length or mid-shaft circumference in group A, both significantly decreased in group B (P < 0.05), and sexual satisfaction of the patients and their partners were 83.3% and 50%, respectively. No serious adverse events were observed except mild complaint of pe- nile skin darkening in 1 case and numb feeling during the intercourse in 2.

CONCLUSIONEarly use of VED after RP improves erectile function and helps to preserve the length and mid-shaft circumference of the penis.

Erectile Dysfunction ; etiology ; therapy ; Humans ; Male ; Middle Aged ; Penile Erection ; Prostatectomy ; adverse effects ; rehabilitation ; Prostatic Neoplasms ; rehabilitation ; surgery ; Treatment Outcome ; Vacuum