Sexual counseling improved erectile rehabilitation after non-nerve-sparing radical retropubic prostatectomy or cystectomy--results of a randomized prospective study.
OBJECTIVE
The efficacy of prostaglandin E1 (PGE1)-intracavernous injection (ICI) therapy for erectile dysfunction (ED) after non-nerve-sparing (NNS) radical pelvic surgery depends on patient compliance. The purpose of this study was to verify the utility of sexual counseling in ICI in terms of treatment efficacy, compliance, and dropout rate.


METHODS
In this prospective randomized study, 57 patients with ED after NNS radical prostatectomy or cystectomy were divided: 29 patients (group SC+) were treated with sexual counseling and PGE1-ICI therapy; the others 28 (group SC-) were treated with only ICI. At the start of the study all patients were administered the International Index of Erectile Function (IIEF) questionnaire and ICI training test; follow-up (at 3, 6, 9, 12, 18 months) was achieved by home Sildenafil test and ambulatory IIEF test; sexual counseling was provided only to group SC+.


RESULTS
The mean IIEF score at the end of study was 26.5 (SC+) vs. 24.3 (SC-) (P < 0.05); eight patients (SC+, 27.5%) became responders to home Sildenafil vs. five (SC-, 17.8%) (P < 0.05); no dropout cases occurred (SC+) vs. eight (SC-, 28.5%) (P < 0.05). Moreover, we recorded best IIEF scores in group SC+ in sexual satisfaction (P < 0.05), sexual desire (P < 0.05), orgasmic function, and general satisfaction. Mean PGE1 doses were better in group SC+ (P < 0.05). ICI-oriented sexual counseling was utilized to motivate couples, to improve sexual intercourses, to correct mistakes in ICI administration. At the end of follow-up 21 patients (SC+) declared themselves satisfied vs. 12 (SC-).


CONCLUSIONS
ICI-oriented sexual counseling in ICI increased the efficacy of treatment, the compliance, and Sildenafil responders rate, decreased the dropout rate.
Department of Urology, University of Padova, Padova 35128, Italy. matteo.titta@libero.it
Matteo
M
Titta
Ivan Matteo
IM
Tavolini
Fabrizio
F
Dal Moro
Antonio
A
Cisternino
Pierfrancesco
P
Bassi
D000368:Aged; D000527:Alprostadil / Q000008:administration & dosage; D015653:Cystectomy / Q000009:adverse effects / Q000534:rehabilitation*; D007172:Erectile Dysfunction / Q000188:drug therapy* / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010879:Piperazines / Q000008:administration & dosage; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects / Q000534:rehabilitation*; D011687:Purines; D012731:Sex Counseling / Q000379:methods*; D000068677:Sildenafil Citrate; D013450:Sulfones; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage*
D010879:Piperazines; D011687:Purines; D013450:Sulfones; D014665:Vasodilator Agents; D000068677:Sildenafil Citrate; D000527:Alprostadil