前列腺癌患者对阴茎康复的态度及影响因素分析
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摘要
目的:探讨前列腺癌患者对于阴茎康复的态度以及哪些因素会影响前列腺癌患者行阴茎康复。方法:回顾性分析2017年1～6月接受根治性前列腺切除术的79例患者,术前对这些患者行IIEF-5问卷调查,以了解这些患者术前一般情况以及对于阴茎康复的接受态度,并在随访中对患者是否进行阴茎康复进行随访。对于无意愿进行阴茎康复以及随访中未进行阴茎康复的患者,对其拒绝阴茎康复的原因予以分析。结果:56例患者(70.9%)表示术后愿意进行阴茎康复,23例(29.1%)表示术后不愿意进行阴茎康复。通过分析发现年龄(P=0.023)、收入水平(P=0.040)、肿瘤分期(P=0.044)、术前性活跃状态(P=0.004)影响患者行阴茎康复的态度。愿意进行阴茎康复组IIEF-5评分明显高于不愿意进行阴茎康复组[(14.75±0.88)分vs(8.48±1.16)分,P=0.000 2]。术后随访过程中,29例患者(36.7%)购买负压勃起装置,50例患者(63.3%)未购买负压勃起装置。收入水平(P<0.01)、肿瘤分期(P=0.004)、是否进行雄激素剥夺治疗(P=0.039)影响患者实际进行阴茎康复与否。加强阴茎康复宣教,可使得因担心同肿瘤治疗相违背而不愿进行阴茎康复的患者比例显著下降(下降45%),而因年龄以及肿瘤分期因素原因导致拒绝阴茎康复的患者比例也在一定程度上下降(分别下降了25%和20%)。治疗费用是导致多数患者拒绝阴茎康复的重要原因。结论:对于前列腺癌患者而言,肿瘤分期以及收入水平能够影响患者是否进行阴茎康复。充分的阴茎康复宣教以及康复费用的降低对于推广阴茎康复进而降低前列腺癌患者术后阴茎萎缩发生率是极为重要的。
Objective: To investigate the attitudes of prostate cancer(PCa) patients towards postoperative penile rehabilitation and their influencing factors. Methods: Seventy-nine PCa patients underwent radical prostatectomy from January through June 2017 and all received a questionnaire investigation before surgery on IIEF-5 and their attitudes towards postoperative penile rehabilitation. We analyzed the reasons for the patients' rejection of postoperative penile rehabilitation. Results: Totally 56(71%) of the patients accepted and the other 23(29%) refused postoperative penile rehabilitation. The factors influencing their attitudes towards penile rehabilitation mainly included age(P = 0.023), income(P = 0.040), tumor stage(P = 0.044), and preoperative sexual activity(P = 0.004). The patients who accepted penile rehabilitation had significantly higher IIEF-5 scores than those who refused it(14.75 ± 0.88 vs 8.48 ± 1.16, P = 0.000 2). During the follow-up period, only 29(36.7%) of the patients bought the vacuum erection device but not the other 50(63.3%). The tumor stage(P = 0.004), income(P < 0.01) and preoperative androgen-deprivation therapy(P = 0.039) significantly influenced the patients' decision on the purchase of the device. Relevant admission education achieved a 45% decrease in the number of the patients unwilling to accept penile rehabilitation for worrying about its negative effect on cancer treatment, a 25% decrease in those rejecting penile rehabilitation because of age, and a 20% decrease in those refusing it due to the tumor stage. The cost of treatment was an important reason for the patients' rejection of postoperative penile rehabilitation. Conclusion: The tumor stage and income are the main factors influencing PCa patients' decision on postoperative penile rehabilitation. Relevant admission education and reduced cost of rehabilitation are important for popularization of postoperative penile rehabilitation in PCa patients. Natl J Androl, 2019, 25(4): 329-332
Objective: To investigate the attitudes of prostate cancer(PCa) patients towards postoperative penile rehabilitation and their influencing factors. Methods: Seventy-nine PCa patients underwent radical prostatectomy from January through June 2017 and all received a questionnaire investigation before surgery on IIEF-5 and their attitudes towards postoperative penile rehabilitation. We analyzed the reasons for the patients' rejection of postoperative penile rehabilitation. Results: Totally 56(71%) of the patients accepted and the other 23(29%) refused postoperative penile rehabilitation. The factors influencing their attitudes towards penile rehabilitation mainly included age(P = 0.023), income(P = 0.040), tumor stage(P = 0.044), and preoperative sexual activity(P = 0.004). The patients who accepted penile rehabilitation had significantly higher IIEF-5 scores than those who refused it(14.75 ± 0.88 vs 8.48 ± 1.16, P = 0.000 2). During the follow-up period, only 29(36.7%) of the patients bought the vacuum erection device but not the other 50(63.3%). The tumor stage(P = 0.004), income(P < 0.01) and preoperative androgen-deprivation therapy(P = 0.039) significantly influenced the patients' decision on the purchase of the device. Relevant admission education achieved a 45% decrease in the number of the patients unwilling to accept penile rehabilitation for worrying about its negative effect on cancer treatment, a 25% decrease in those rejecting penile rehabilitation because of age, and a 20% decrease in those refusing it due to the tumor stage. The cost of treatment was an important reason for the patients' rejection of postoperative penile rehabilitation. Conclusion: The tumor stage and income are the main factors influencing PCa patients' decision on postoperative penile rehabilitation. Relevant admission education and reduced cost of rehabilitation are important for popularization of postoperative penile rehabilitation in PCa patients. Natl J Androl, 2019, 25(4): 329-332
引文
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[2] Siegel RL,Miller KD,Jemal A.Cancer statistics,2018.CA Cancer J Clin,2018,68(1):7-30.
[3] Carlsson S,Nilsson AE,Johansson E,et al.Selfperceived penil shortening after radical prostatectomy.Int J Impot Res,2012,24(5):179-184.
[4] Kwon YS,Farber N,Yu JW,et al.Longitudinal recovery patterns of penile length and the underexplored benefit of long-term phosphodiesterase-5 inhibitor use after radical prostatectomy.BMC Urol,2018,18(1):37.
[5] 沈益君,叶定伟,姚旭东,等.负压勃起装置治疗前列腺癌根治术后的勃起功能障碍.中华男科学杂志,2012,18(8):723-726.
[6] Shen YJ,Li J,Ye DW.Penile rehabilitation after radical prostatectomy:Patients' attitude and feasibility in China.Transl Androl Urol,2013,2(1):4-9.
[7] Polito M,d'Anzeo G,Conti A,et al.Erectile rehabilitation with intracavernous alprostadil after radical prostatectomy:refusal and dropout rates.BJU Int,2012,110(11 Pt C):E954-E957.
[8] Savoie M1,Kim SS,Soloway MS.A prospective study measuring penile length in men treated with radical prostatectomy for prostate cancer.J Urol,2003,169(4):1462-1464.
[9] Mondaini N,Cai T,Sarti E,et al.A case series of patients who underwent laparoscopic extraperitoneal radical prostatectomy with the simultaneous implant of a penile prosthesis:Focus on penile length preservation.World J Mens Health,2018,36(2):132-138.
[10] Qin F,Wang S,Li J,et al.The early use of vacuum therapy for penile rehabilitation after radical prostatectomy:Systematic review and meta-analysis.Am J Mens Health,2018,12(6):2136-2143.
[11] 林浩成,Grace Wang,Run Wang.真空勃起装置在前列腺癌根治术后阴茎康复治疗中的应用.中华男科学杂志,2015,21(3):195-199.
[12] Gontero P,Galzerano M,Bartoletti R,et al.New insights into the pathogenesis of penile shortening after radical prostatectomy and the role of postoperative sexual function.J Urol,2007,178(2):602-607
[13] Hoyland K,Vasdev N,Adshead J.The use of vacuum erection devices in erectile dysfunction after radical prostatectomy.Rev Urol,2013,15(2):67-71.
[14] K?hler TS,Pedro R,Hendlin K,et al.A pilot study on the early use of the vacuum erection device after radical retropubic prostatectomy.BJU Int,2007,100(4):858-862.
[15] Engel JD.Effect on sexual function of a vacuum erection device post-prostatectomy.Can J Urol,2011,18(3):5721-5725.
[16] Salonia A,Gallina A,Zanni G,et al.Acceptance of and discontinuation rate from erectile dysfunction oral treatment in patients following bilateral nerve-sparing radical prostatectomy.Eur Urol,2008,53(3):564-570.
[2] Siegel RL,Miller KD,Jemal A.Cancer statistics,2018.CA Cancer J Clin,2018,68(1):7-30.
[3] Carlsson S,Nilsson AE,Johansson E,et al.Selfperceived penil shortening after radical prostatectomy.Int J Impot Res,2012,24(5):179-184.
[4] Kwon YS,Farber N,Yu JW,et al.Longitudinal recovery patterns of penile length and the underexplored benefit of long-term phosphodiesterase-5 inhibitor use after radical prostatectomy.BMC Urol,2018,18(1):37.
[5] 沈益君,叶定伟,姚旭东,等.负压勃起装置治疗前列腺癌根治术后的勃起功能障碍.中华男科学杂志,2012,18(8):723-726.
[6] Shen YJ,Li J,Ye DW.Penile rehabilitation after radical prostatectomy:Patients' attitude and feasibility in China.Transl Androl Urol,2013,2(1):4-9.
[7] Polito M,d'Anzeo G,Conti A,et al.Erectile rehabilitation with intracavernous alprostadil after radical prostatectomy:refusal and dropout rates.BJU Int,2012,110(11 Pt C):E954-E957.
[8] Savoie M1,Kim SS,Soloway MS.A prospective study measuring penile length in men treated with radical prostatectomy for prostate cancer.J Urol,2003,169(4):1462-1464.
[9] Mondaini N,Cai T,Sarti E,et al.A case series of patients who underwent laparoscopic extraperitoneal radical prostatectomy with the simultaneous implant of a penile prosthesis:Focus on penile length preservation.World J Mens Health,2018,36(2):132-138.
[10] Qin F,Wang S,Li J,et al.The early use of vacuum therapy for penile rehabilitation after radical prostatectomy:Systematic review and meta-analysis.Am J Mens Health,2018,12(6):2136-2143.
[11] 林浩成,Grace Wang,Run Wang.真空勃起装置在前列腺癌根治术后阴茎康复治疗中的应用.中华男科学杂志,2015,21(3):195-199.
[12] Gontero P,Galzerano M,Bartoletti R,et al.New insights into the pathogenesis of penile shortening after radical prostatectomy and the role of postoperative sexual function.J Urol,2007,178(2):602-607
[13] Hoyland K,Vasdev N,Adshead J.The use of vacuum erection devices in erectile dysfunction after radical prostatectomy.Rev Urol,2013,15(2):67-71.
[14] K?hler TS,Pedro R,Hendlin K,et al.A pilot study on the early use of the vacuum erection device after radical retropubic prostatectomy.BJU Int,2007,100(4):858-862.
[15] Engel JD.Effect on sexual function of a vacuum erection device post-prostatectomy.Can J Urol,2011,18(3):5721-5725.
[16] Salonia A,Gallina A,Zanni G,et al.Acceptance of and discontinuation rate from erectile dysfunction oral treatment in patients following bilateral nerve-sparing radical prostatectomy.Eur Urol,2008,53(3):564-570.