title: Psychotherapy: a missing piece in the puzzle of post radical prostatectomy erectile dysfunction rehabilitation.
abstract: OBJECTIVE
  To measure the impact of psychotherapy associated to the use of Tadalafil in the improvement of erectile function after radical prostatectomy.
  
  
  METHODS
  From 132 patients surgically treated for prostate cancer, thirty sequential patients with bilateral nerve sparing, low risk controlled disease and post-surgery erectile dysfunction (ED) took Tadalafil 20mg and underwent psychotherapy sessions, both weekly for three months. Patients were interviewed to establish the quality of erection using the instrument IIEF-5 and to measure psychological features impacting erectile function, aspects related to function, dysfunction, physical and emotional discomfort were evaluated with the help of an intensity scale.
  
  
  RESULTS
  The average age was 62.5 (46 to 77 years), 96.7% had a stable relationship, 56.6% of the patients accepted the diagnosis and 43.2% exhibited defense mechanisms (3.3% negation, 6.6% revulsion, 33.3% concern). A positive correlation was observed between erectile function and time exposed to treatment (IIEF-5 - 9.7 to 13.3, p=0.0006), with increased satisfaction with life in general (2.1 to 2.7, P=.028) and sexual life (3.1 to 3.7, P=.028), added to facilitation of expressing feelings/emotions (1.8 to 3.0, P=.0008). Satisfaction with relationship and intimacy with partner did not present significant improve (P=.12 and P=.61, respectively).
  
  
  CONCLUSIONS
  A holistic patient care with more complete ED rehabilitation includes psychotherapy with a positive correlation between erectile function and treatment exposition. Psychotherapy allowed the identification of important spouse related factors in this scenario.
authors.affiliation: Escuela de Ciencias Médicas, Universidad de Campinas, Unicamp, São Paulo, Brasil.
authors.forename: A M
authors.initials: AM
authors.lastname: Naccarato
authors.affiliation: Escuela de Ciencias Médicas, Universidad de Campinas, Unicamp, São Paulo, Brasil. Electronic address: reisleo@unicamp.br.
authors.forename: L O
authors.initials: LO
authors.lastname: Reis
authors.affiliation: Escuela de Ciencias Médicas, Universidad de Campinas, Unicamp, São Paulo, Brasil.
authors.forename: E L
authors.initials: EL
authors.lastname: Zani
authors.affiliation: Escuela de Ciencias Médicas, Universidad de Campinas, Unicamp, São Paulo, Brasil.
authors.forename: M
authors.initials: M
authors.lastname: Cartapatti
authors.affiliation: Escuela de Ciencias Médicas, Universidad de Campinas, Unicamp, São Paulo, Brasil.
authors.forename: F
authors.initials: F
authors.lastname: Denardi
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D007172:Erectile Dysfunction / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use*; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects; D011613:Psychotherapy; D000068581:Tadalafil / Q000627:therapeutic use*
chemical_list: D058986:Phosphodiesterase 5 Inhibitors; D000068581:Tadalafil
keywords: Calidad de vida; Cónyuge; Erectile function; Función eréctil; International Index of Erectile Function; Male; Masculino; Quality of life; Sex; Sexo; Spouse