Patient and partner focus needed in rehab after prostatectomy

By Sally Robertson, B.Sc.Oct 24 2012

Most patients who undergo radical prostatectomy (RP) are keen to attend a rehabilitation program to help recover sexual potency, but the process can be frustrating and demanding, with high patient dropout rates, say researchers.

Appropriate support for both the patient and their partner is required to motivate patients to pursue rehabilitation programs after a traumatic procedure such as RP, say Massimo Polito (Polytechnic University of the Marches Region Medical School, Ancona, Italy) and colleagues.

"Although many studies have addressed the main questions about efficacy of different approaches to ED [erectile dysfunction], there is a lack of data about adherence to therapy and the main reasons why patients drop out of these programmes," explains the team.

In a follow-up study of 430 patients who underwent RP between January 2007 and December 2009, the researchers report that all were offered an ED rehabilitation program with the prostaglandin E, alprostadil. All patients (mean age 65 years) reported being sexually active during the 6 months before undergoing surgery, although 66.7% had an International Index of Erectile Function (IIEF-5) score of at least 20.

About 4 weeks after surgery, patients were counseled about the aims of the rehabilitation protocol and the potential complications involved.

Patients who agreed to participate were seen once a week and taught to self-inject alprostadil, beginning with a dose of 2-3 mcg, which was optimized at the next visit based on erection response.

As reported in BJU International, the rehabilitation program was accepted by 273 (63.5%) patients, while 157 (36.5%) refused it.

Questionnaire responses showed that refusal to participate was mainly due to patients' lack of sexual interest (in 51.2% of cases) and lack of interest from the spouse or partner (in 30.2% of cases).

"The present data highlight the role of spouses/partners, whose lack of interest in sexual intercourse was the underlying reason for approximately 30% of negative decisions," write Polito and colleagues. "This surprising factor must be a focus of the postoperative management of what is, in effect, no longer a single patient, but a more complex entity, the couple."

Of the 273 patients who did take part in the program, 51 (18.6%) dropped out over the first 6 months.

In the majority of cases, treatment ineffectiveness or disappointment with its effects were reported as the main reason for dropout, while the second most frequent reason given was injection pain.

Factors influencing patients' refusal to participate in the program and decisions to drop out of the program were both patient- and partner-related, say the researchers.

"The management of these subjects would benefit from a change of focus, from the patient to the couple viewed as a single and complex player," they conclude.

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