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Unal S, Kutluhan MA, Uzundal H, Soydas T, Okulu E, Ozayar A, Kayigil O. The effect of puboperiurethral suspension stitch placement on climacturia after robot-assisted laparoscopic radical prostatectomy. J Sex Med 2024:qdae130. [PMID: 39351841 DOI: 10.1093/jsxmed/qdae130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 08/11/2024] [Accepted: 09/17/2024] [Indexed: 10/03/2024]
Abstract
BACKGROUND Climacturia is defined as urine leakage associated with orgasm and can negatively affect patients' quality of life. The high prevalence of climacturia after radical prostatectomy (RP) has led to continued efforts to reduce climacturia rates. It has been shown that puboperiurethral suspension stitch placement during RP assists in the recovery of urinary continence. AIM To evaluate the impact of puboperiurethral suspension stitch placement during RP on post-RP climacturia. METHODS We conducted a retrospective study of patients who underwent nerve-sparing robot-assisted laparoscopic RP (RALP) at our institution between 2016 and 2023. The patients were categorized into 2 groups: Group 1 (n = 32) that underwent nerve-sparing RALP with puboperiurethral suspension stitch placement and Group 2 (n = 62) that underwent nerve-sparing RALP alone. Patients who were not able to achieve penetration at the last follow-up visit were excluded from the study. The clinical history, parameters of prostate cancer, details of medical and surgical treatments, and follow-up data were evaluated. OUTCOMES Differences in sexual and urinary function, climacturia rates, and complications between nerve-sparing RP with and without puboperiurethral suspension stitch placement. RESULTS There were no significant differences between the groups in terms of surgical complications. The mean follow-up time was 14.62 ± 3.55 months in Group 1 and 14.43 ± 4.44 months in Group 2 (P = .42). Postoperative erectile functions were similar between the groups. At the last follow-up visit, climacturia was present in 4 patients (12.5%) in Group 1 and 24 patients (38.7%) in Group 2 (P = .016). The long-term stress urinary incontinence rates were similar between the groups. CLINICAL IMPLICATIONS This study provides comparative results on postoperative climacturia rates between nerve-sparing RALP groups with and without puboperiurethral suspension stitch placement. These results show that puboperiurethral suspension stitch can help to prevent postoperative climacturia after RP. STRENGTH AND LIMITATIONS This is the first study in the literature that evaluates the effect of puboperiurethral suspension stitch on climacturia. The limitations include the single-center, retrospective design with potential selection bias, possible inaccuracies in the recorded medical data, and challenges in controlling confounding variables. CONCLUSION Our study demonstrated that puboperiurethral suspension stitch was a feasible option for the prevention of climacturia after RALP without an increased risk of complications.
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Affiliation(s)
- Selman Unal
- Department of Urology, Urgup State Hospital, Nevsehir, 50400, Turkey
| | - Musab Ali Kutluhan
- Department of Urology, Ankara Yildirim Beyazit University School of Medicine, Ankara, 06800, Turkey
| | - Halil Uzundal
- Department of Urology, Mamak State Hospital, Ankara, 06270, Turkey
| | - Turker Soydas
- Department of Urology, Ankara Etlik City Hospital, Ankara, 06170, Turkey
| | - Emrah Okulu
- Department of Urology, Ankara Yildirim Beyazit University School of Medicine, Ankara, 06800, Turkey
| | - Asim Ozayar
- Department of Urology, Ankara Yildirim Beyazit University School of Medicine, Ankara, 06800, Turkey
| | - Onder Kayigil
- Department of Urology, Ankara Yildirim Beyazit University School of Medicine, Ankara, 06800, Turkey
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Shaw C, Wagg A. Penile compression devices for the treatment of urinary incontinence: current status and future prospects. Expert Rev Med Devices 2024; 21:811-817. [PMID: 39230092 DOI: 10.1080/17434440.2024.2400092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 08/30/2024] [Indexed: 09/05/2024]
Abstract
INTRODUCTION Urinary incontinence (UI), especially stress UI, is common after prostatectomy. Penile compression devices (PCDs) may be a safe, tolerable option for conservative management in men who are not candidates for or not interested in surgical intervention for their UI. AREAS COVERED This article examines the epidemiology of post-prostatectomy urinary incontinence (PPI), and options for management. All available studies on PCDs are explored, including those on biomechanics, safety, tolerability, and user experience. History, availability of PCDs, and areas for future development are discussed. EXPERT OPINION PCDs are an option for conservative management of PPI. They are recommended for those men without impairment in cognition, dexterity, or sensation. They should be worn for short periods of time and are best used during situations when incontinence might be precipitated. Overall, data suggest they are well tolerated and effective when tested, but large randomized comparative trials and studies of long-term use with relevant patient reported outcome measures are lacking. More studies are needed on commercially available PCDs. Biomechanical studies suggest that there are superior designs and materials both for efficacy and tolerability. With an aging population, and more older men going for prostate surgery, a larger market for these devices is likely.
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Affiliation(s)
- Christina Shaw
- Division of Geriatric Medicine, Department of Medicine, University of Alberta, Edmonton, Canada
- Division of Geriatric Medicine, Department of Medicine, University of British Columbia in Vancouver, Vancouver, Canada
| | - Adrian Wagg
- Division of Geriatric Medicine, Department of Medicine, University of Alberta, Edmonton, Canada
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Farraj H, Alriyalat S. Urinary Incontinence Following Robotic-Assisted Radical Prostatectomy: A Literature Review. Cureus 2024; 16:e53058. [PMID: 38410341 PMCID: PMC10896250 DOI: 10.7759/cureus.53058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2024] [Indexed: 02/28/2024] Open
Abstract
Prostate cancer ranks as one of the most prevalent cancers among men in the United States, contributing significantly to cancer-related mortality. Robot-assisted radical prostatectomy (RARP) has become a cornerstone in the management of localized prostate cancer. This literature review delves into the outcomes of RARP, specifically its impact on urinary incontinence (UI) compared to other surgical methods. We also present the importance of patient perception versus medical reports. Recent studies and trials have unveiled that postoperative UI and erectile dysfunction (ED) remain common concerns following prostatectomy. However, studies have shown that RARP has lower occurrences of UI and ED compared to radical retropubic prostatectomy (RRP). While the choice of surgical method may not drastically affect these outcomes, the review emphasizes that urinary incontinence extends beyond physical symptoms. It profoundly impacts patients' psychological well-being, social interactions, and overall quality of life. Differences in symptom recording and interpretation between patients and healthcare professionals can significantly influence the diagnosis and treatment of prostate cancer. Enhanced patient-physician communication and patient-centered care are essential to providing a holistic approach to prostate cancer management. The choice of surgical methods may not significantly impact postoperative urinary incontinence and erectile dysfunction. Continued research and advancements in treatment and patient care are crucial for improving outcomes and the overall well-being of prostate cancer patients.
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Affiliation(s)
- Hamzeh Farraj
- Department of Special Surgery, Division of Urology, Al-Balqa Applied University, Salt, JOR
| | - Sulieman Alriyalat
- Department of Special Surgery, Division of Urology, Al-Balqa Applied University, Salt, JOR
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Mandel A, Das C, Ting R, Kaufmann B, Tewari A. Intraoperative Fluorescent Image Guidance for Nerve-Sparing Prostatectomy: A Review of Historical Context and Current Research. J Endourol 2024; 38:30-39. [PMID: 37850492 DOI: 10.1089/end.2023.0480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
Fluorescent probes in the near-infrared (NIR) range have immense potential to improve observation of positive margins, lymph nodes, and nerves in prostatectomy. Development of fluorescent dyes and mechanisms of cellular uptake paved the way for the current emerging technologies. However, intracellular transport of fluorophores proved to be logistically challenging with respect to intraoperative deployment. Peptide-based probes with high specificity for nerves enabled broader and more rapid labeling. Key features of the ideal probe include selectivity, minimal background noise, safety, and low cost. Human neuropeptide 401 (HNP401) and oxazine-based probes perform well in these categories. As for tumor-specific labeling, prostate specific membrane antigen is relatively selective for the prostate and can be conjugated to a fluorophore. NIR spectrum emission is an ideal range for clinical imaging use, as fluorescence occurs outside the field of visible light, and tissue optical properties diverge significantly at the visible-NIR transition. Indocyanine, carbocyanine, and fluorescein derivatives are common fluorophore conjugates for the probes. Finally, to harness the power of fluorescence intraoperatively, the surgeon must look through a specialized lens. Multiphoton microscopy, optical coherence tomography, and confocal laser endomicroscopy have emerged as frontrunners in this arena. As with any evolving technology, ongoing research is expanding the applications of fluorescent intraoperative imaging in prostate surgery. Innovations in camera technology, dye selection, and image processing are refining the technique's capabilities. A core challenge of these technologies translating into the operating room relates to size and the ability to view objects at vastly different magnifications. Dual modality zoom settings are promising solutions. Furthermore, interdisciplinary collaboration between surgeons, imaging specialists, and researchers continues to drive advancements. In conclusion, fluorescent intraoperative imaging has the potential to usher in a new era of precision and safety in prostate surgery.
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Affiliation(s)
- Asher Mandel
- The Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Chandan Das
- The Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Basil Kaufmann
- The Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Ashutosh Tewari
- The Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Fanshawe JB, Wai-Shun Chan V, Asif A, Ng A, Van Hemelrijck M, Cathcart P, Challacombe B, Brown C, Popert R, Elhage O, Ahmed K, Brunckhorst O, Dasgupta P. Decision Regret in Patients with Localised Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol Oncol 2023; 6:456-466. [PMID: 36870852 DOI: 10.1016/j.euo.2023.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/17/2023] [Accepted: 02/15/2023] [Indexed: 03/06/2023]
Abstract
CONTEXT Treatment choice for localised prostate cancer remains a significant challenge for patients and clinicians, with uncertainty over decisions potentially leading to conflict and regret. There is a need to further understand the prevalence and prognostic factors of decision regret to improve patient quality of life. OBJECTIVE To generate the best estimates for the prevalence of significant decision regret localised prostate cancer patients, and to investigate prognostic patient, oncological, and treatment factors associated with regret. EVIDENCE ACQUISITION We performed a systematic search of MEDLINE, Embase, and PsychINFO databases including studies evaluating the prevalence or patient, treatment, or oncological prognostic factors in localised prostate cancer patients. A pooled prevalence of significant regret was calculated with the formal prognostic factor evaluation conducted per factor identified. EVIDENCE SYNTHESIS Significant decision regret was present in a pooled 20% (95% confidence interval 16-23) of patients across 14 studies and 17883 patients. This was lower in active surveillance (13%), with little difference between those who underwent radiotherapy (19%) and those who underwent prostatectomy (18%). Evaluation of individual prognostic factors demonstrated higher regret in those with poorer post-treatment bowel, sexual, and urinary function; decreased involvement in the decision-making process; and Black ethnicity. However, evidence remains conflicting, with low or moderate certainty of findings. CONCLUSIONS A significant proportion of men experience decision regret after a localised prostate cancer diagnosis. Monitoring those with increased functional symptoms and improving patient involvement in the decision-making process through education and decision aids may reduce regret. PATIENT SUMMARY We looked at how common regret in treatment decisions is after treatment for early-stage prostate cancer and factors linked with this. We found that one in five regret their decision, with those who had experienced side effects or were less involved in the decision-making process more likely to have regret. By addressing these, clinicians could reduce regret and improve quality of life.
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Affiliation(s)
| | - Vinson Wai-Shun Chan
- Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK; Leeds Institute of Medical Research, School of Medicine, University of Leeds, Leeds, UK; Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Aqua Asif
- Division of Surgery and Interventional Sciences, University College London, London, UK; Royal Surrey NHS Foundation Trust, Surrey, UK
| | - Alexander Ng
- Division of Surgery and Interventional Sciences, University College London, London, UK; Royal Free London NHS Foundation Trust, London, UK
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Paul Cathcart
- Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Ben Challacombe
- Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Christian Brown
- Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Rick Popert
- Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Oussama Elhage
- Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK; School of Immunology and Microbial Sciences, King's College London, King's Health Partners, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK; Department of Urology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; Khalifa University, Abu Dhabi, United Arab Emirates
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK
| | - Prokar Dasgupta
- Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK; MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK
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Li L, Xu Y, Xu Z, Qi F, Li X. Misclassification of Gleason grade and tumor stage in Asian‐American patients with low‐risk prostate cancer. PRECISION MEDICAL SCIENCES 2023. [DOI: 10.1002/prm2.12098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Affiliation(s)
- Lu Li
- Student of Nanjing Medical University Nanjing China
| | - Yihang Xu
- Student of The First Clinical Medical College of Nanjing Medical University Nanjing China
| | - Zicheng Xu
- Department of Urologic Surgery Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Feng Qi
- Department of Urologic Surgery Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Xiao Li
- Department of Urologic Surgery Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
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Pikramenos K, Zachou M, Papadopoulos D, Papatsoris A, Varkarakis I, Mitsogiannis I. Post Radical Prostatectomy Erectile Dysfunction. A Single Centre Experience. Cureus 2023; 15:e34601. [PMID: 36883073 PMCID: PMC9985922 DOI: 10.7759/cureus.34601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION This study aims to determine the effects of radical retropubic prostatectomy on post-operative erectile function. MATERIALS & METHODS A total of 50 patients were included in this study, diagnosed with localized prostate cancer, and underwent nerve-sparing radical retropubic prostatectomy. All patients completed the International Index of Erectile Function (IIEF-5) questionnaire pre-operatively and on the third, sixth, and twelfth post-operative month and completed a self-reporting of their satisfaction with their sexual performance. Patients with a history of severe heart disease, were on erectile dysfunction medication, or had a score of 7 or less on the IIEF-5 questionnaire, were excluded from the study. RESULTS Pre-operatively it was observed that the lower the IIEF-5 score, the higher the biopsy Gleason score. Post-operatively, 16 patients stated that erectile function had returned to the pre-operative IIEF-5 category. In contrast, only 13 of them stated they were happy with their sexual performance on the self-reporting scale. The rest reported dissatisfaction despite returning to their pre-operative erectile function status. IIEF-5 scores were also different when compared amongst the four age groups, with scores indicating that younger age is related to higher IIEF-5 scores. At the 3-month follow-up, no statistically significant difference was observed between age groups. Finally, patients younger than 64 reported significantly less deterioration in post-operative erectile function. CONCLUSION Post-radical prostatectomy erectile dysfunction remains one of the most pressing issues in prostate cancer therapy. A higher Gleason score has a more significant impact on pre-operative ED, and at the same time, the best post-operative ED results are observed in younger patients. Finally, patients need extensive follow-up, therapy, and pre-and post-operative psychological support to have the best possible erectile function.
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Affiliation(s)
- Konstantinos Pikramenos
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanoglio General Hospital, Athens, GRC
| | - Maria Zachou
- Gastroenterology, National and Kapodistrian University of Athens, Athens, GRC.,Gastroenterology, Sismanoglio General Hospital, Athens, GRC
| | - Dimitrios Papadopoulos
- Anaesthesiology, Evgenidio Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Athanasios Papatsoris
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanoglio General Hospital, Athens, GRC
| | - Ioannis Varkarakis
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanoglio General Hospital, Athens, GRC
| | - Iraklis Mitsogiannis
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanoglio General Hospital, Athens, GRC
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Unal S, Kutluhan MA, Okulu E, Ozayar A, Kayigil O. Effect of endoscopic urethral procedures applied after robotic radical prostatectomy on urinary incontinence: A prospective cohort pilot study. Urologia 2022; 90:141-145. [PMID: 35471090 DOI: 10.1177/03915603221093733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The most common complications after radical prostatectomy (RP) are erectile dysfunction (ED) and urinary incontinence (UI). After RP, patients may require endoscopic urethral procedures (EUP) for other urological diseases such as hematuria, urinary system stone disease, and suspicion of bladder tumor. In clinical practice we observed that EUP performed after robot assisted RP (RARP) can cause an increase in the UI level. In this study, we investigated whether there is a change in the UI level in patients that underwent EUP after RARP and whether this change was affected by the duration of the procedure and type of endoscopic device used. MATERIAL AND METHODS Twenty-six patients were included who underwent EUP after RARP in this study. The patients were divided into three groups based on the endoscopic device used: group 1 rigid cystoscopy (n = 9), group 2 flexible cystoscopy (n = 7), and group 3 semi-rigid ureterorenoscopy (URS) (n = 10). The Turkish version of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-SF) and the number of pads used daily was questioned before the EUP and 1 month after the procedure. RESULTS While a significant increase in ICIQ-SF score was observed in group 1 (p = 0.027), no significant increase was observed in group 2 and group 3 (p > 0.05). No significant difference was observed between the number of pads used preoperatively and the postoperative first month in all groups (p > 0.05). There was no significant correlation between increased operation time and both the pad usage and ICIQ-SF score (p > 0.05). CONCLUSION The use of small diameter endoscopic instruments and flexible instruments is important for patient comfort and to avoid damage to urethrovesical anastomosis in patients who need to undergo EUP after RP.
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Affiliation(s)
- Selman Unal
- Department of Urology, Ankara Yildirim Beyazit University School of Medicine, Ankara, Turkey
| | - Musab Ali Kutluhan
- Department of Urology, Ankara Yildirim Beyazit University School of Medicine, Ankara, Turkey
| | - Emrah Okulu
- Department of Urology, Ankara Yildirim Beyazit University School of Medicine, Ankara, Turkey
| | - Asim Ozayar
- Department of Urology, Ankara Yildirim Beyazit University School of Medicine, Ankara, Turkey
| | - Onder Kayigil
- Department of Urology, Ankara Yildirim Beyazit University School of Medicine, Ankara, Turkey
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Kim MS, Jung SI, Chung HS, Chang Hwang E, Kwon D. Effects of leuprolide acetate on the quality of life of patients with prostate cancer: A prospective longitudinal cohort study. Prostate Int 2021; 9:132-139. [PMID: 34692585 PMCID: PMC8498686 DOI: 10.1016/j.prnil.2020.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/28/2020] [Accepted: 11/09/2020] [Indexed: 11/12/2022] Open
Abstract
Purpose The aim of this study was to investigate the effect of androgen deprivation therapy (ADT) on the health-related quality of life (HRQOL) of patients with prostate cancer (PC) and compare the changes in the HRQOL between ADT alone and ADT plus intensity-modulated radiation therapy (IMRT). Materials and methods Patients with PC were prospectively recruited between October 2018 and April 2020. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and the PC-specific module (PR25) were administered before ADT (baseline) and at 3, 6, and 12 months after ADT. All patients received subcutaneous injections of 45 mg leuprolide acetate at 6-month intervals for 12 months. Results Fifty-five of the 71 patients (77.5%) completed the 12-month study. Twenty-two of the 55 patients received IMRT. There were no differences in the baseline characteristics with respect to IMRT. Compared with baseline, physical function and role function deteriorated after 3 months (p = 0.003, p = 0.019). However, the global quality of life (QOL) did not change over time. The symptom scales of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire indicated that there was a statistically significant deterioration in dyspnea and fatigue symptoms at 12 months (p = 0.004, p = 0.004). Responses to the QLQ-PR25 revealed that patients experienced an increase in hormonal treatment-related symptoms after 3, 6, and 12 months (p = 0.002, 0.001, and 0.004). Comparisons between the ADT group and ADT plus IMRT group showed that body function and role function did not differ between the two groups (p = 0.815, p = 0.759), and there was also no difference in global QOL (p = 0.624). Conclusion Our results indicate that treatment with leuprolide acetate at 6-month intervals was not accompanied by changes in global QOL, despite deterioration of body and role functions and hormonal treatment-related symptoms. The combination of ADT and IMRT did not lead to additional deterioration in the HRQOL.
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Affiliation(s)
| | - Seung Il Jung
- Corresponding author. Department of Urology, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeonnam, 58128, Republic of Korea.
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Baumann FT, Reimer N, Gockeln T, Reike A, Hallek M, Ricci C, Zopf EM, Schmid D, Taaffe D, Newton RU, Galvao DA, Leitzmann M. Supervised pelvic floor muscle exercise is more effective than unsupervised pelvic floor muscle exercise at improving urinary incontinence in prostate cancer patients following radical prostatectomy - a systematic review and meta-analysis. Disabil Rehabil 2021; 44:5374-5385. [PMID: 34550846 DOI: 10.1080/09638288.2021.1937717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Urinary incontinence is one of the most clinically relevant side effects in the treatment of prostate cancer patients. The aim of this systematic review and meta-analysis was to analyze the specific exercise effects of supervised versus unsupervised pelvic floor muscle exercise (PFME) and exercise volume on urinary incontinence status after radical prostatectomy. METHODS A systematic data search was performed for studies published from January 2000 to December 2020 using the following databases: PubMed, Embase, SciSearch, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews and Effects. The review was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A random-effects meta-analysis of urinary incontinence remission was performed. The relation between time since surgery and urinary incontinence remission was analyzed using a non-linear dose-response meta-analysis. RESULTS The meta-analysis included 20 randomized controlled trials involving 2188 men (n = 1105 in intervention groups; n = 1083 in control groups). PFME versus no PFME had a beneficial effect on urinary incontinence remission at 3 months, 3-6 months, and more than 6 months post-surgery, with risk differences ranging from 12 to 25%. These effects were particularly evident for higher volume, supervised PFME in the first 6 months post-surgery. Additional biofeedback therapy appeared to be beneficial but only during the first 3 months post-surgery. CONCLUSIONS There is good evidence that the supervised PFME causes a decrease in short-term urinary incontinence rates. Unsupervised PFME has similar effects as no PFME in postoperative urinary incontinence. PFME programs should be implemented as an early rehabilitative measure to improve postoperative short-term urinary incontinence in patients with prostate cancer.IMPLICATIONS FOR REHABILITATIONProstate cancer, surgery, and urinary incontinenceThe surgical treatment of prostate cancer often leads to urinary incontinence.Pelvic floor training leads to a significant improvement of this situation.Exercise therapy support is very important in this context and is even more effective than unsupported training.
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Affiliation(s)
- Freerk T Baumann
- Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - Nadine Reimer
- Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - Theresa Gockeln
- Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - Alexandra Reike
- Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - Christian Ricci
- Centre of Excellence for Nutrition, Nutritional Epidemiology and Biostatistics, North West University South Africa, Potchefstroom, South Africa
| | - Eva M Zopf
- Faculty of Health Sciences, Mary MacKillop Institute for Health Research, Department Melbourne, Australian Catholic University, Melbourne, Australia
| | - Daniela Schmid
- Division for Quantitative Methods in Public Heallth and Health Services Research, Private University of Health Sciences Medical Informatics and Technology, Hall, Austria
| | - Dennis Taaffe
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Robert U Newton
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Daniel A Galvao
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Michael Leitzmann
- Faculty of Medicine, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
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11
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Shen Q, Ma Y, Jöud A, Schelin MEC, Fall K, Andrén O, Fang F. Psychiatric Disorders and Cardiovascular Diseases During the Diagnostic Workup of Suspected Prostate Cancer. JNCI Cancer Spectr 2020; 5:pkaa108. [PMID: 33554033 PMCID: PMC7853179 DOI: 10.1093/jncics/pkaa108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/16/2020] [Accepted: 10/22/2020] [Indexed: 12/02/2022] Open
Abstract
Background It is unknown whether the rate of psychiatric disorders and cardiovascular disease increases during the diagnostic workup of suspected prostate cancer. Methods We designed a population-based cohort study including 579 992 men living during 2005-2014 in Skåne, Sweden, according to the Swedish Total Population Register and the Skåne Healthcare Register (SHR). We used the Swedish Cancer Register and the SHR to identify all men with a new diagnosis of prostate cancer (N = 10 996), and all men underwent a prostate biopsy without receiving a cancer diagnosis (biopsy group, N = 20 482) as exposed to a diagnostic workup. Using Poisson regression, we compared the rates of psychiatric disorders and cardiovascular disease during the period before diagnosis or biopsy of exposed men with the corresponding rates of unexposed men. Results We found an increased rate of psychiatric disorders during the period before diagnosis or biopsy among men with prostate cancer (incidence rate ratio [IRR] = 1.87, 95% confidence interval [CI] = 1.67 to 2.10) and men in the biopsy group (IRR = 2.22, 95% CI = 2.08 to 2.37). The rate of cardiovascular disease increased during the period before diagnosis or biopsy among men with prostate cancer (IRR = 2.22, 95% CI = 2.12 to 2.32) and men in the biopsy group (IRR = 2.56, 95% CI = 2.49 to 2.63). Greater rate increases were noted for a diagnostic workup due to symptoms than due to other reasons. Conclusions There was an increased risk of psychiatric disorders and cardiovascular disease during the diagnostic workup of suspected prostate cancer regardless of the final cancer diagnosis.
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Affiliation(s)
- Qing Shen
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Correspondence to: Qing Shen, PhD, Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Box 210, Nobels väg 13, 171 77 Stockholm, Sweden (e-mail: ) and Fang Fang, Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Box 210, 171 77 Stockholm, Sweden (e-mail: )
| | - Yuanjun Ma
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Anna Jöud
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine Lund, Lund University, Lund, Sweden
| | - Maria E C Schelin
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine Lund, Lund University, Lund, Sweden
| | - Katja Fall
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Ove Andrén
- Department of Urology, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Fang Fang
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Correspondence to: Qing Shen, PhD, Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Box 210, Nobels väg 13, 171 77 Stockholm, Sweden (e-mail: ) and Fang Fang, Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Box 210, 171 77 Stockholm, Sweden (e-mail: )
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12
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Lemmens J, Peko Cohen L, Worsley PR, Everitt C, Broadbridge J, Gefen A, Rees RW, Drake M, Macaulay MC, Fader M, Bader DL. Magnetic resonance imaging to estimate tissue deformations during penile clamp application: A case series. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415820920511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:Penile clamps provide a means of preventing urinary incontinence in males following radical prostatectomy. In order for the devices to function, significant mechanical loads need to be applied to the penile tissues to close the urethra. However, such loads have the potential to cause damage to the vulnerable skin and underlying soft tissues. Accordingly, the study aimed to estimate the magnitudes of tissue deformations resulting from penile clamp application in three individual cases.Methods:Three individuals were recruited who currently use penile clamps to manage urinary incontinence following radical prostatectomy. Magnetic resonance images (MRI) of the penis were taken to produce a series of high contrast coronal and sagittal images both before and during the application of two commercially available clamps, modified for MRI compatibility. Tissue thickness measurements were estimated with the clamps in-situ and normalised to the unloaded baseline state.Results:The estimated magnitude of tissue deformations resulting from clamp application ranged between 68% and 84%. There were minimal differences in these deformations between the clamp designs, both of which appeared effective in closing the urethra. Local stress concentrations were observed in the tissues, which were deformed around the shape of the clamp.Conclusions:MRI enabled quantification of local tissue deformation during penile clamp application. The results revealed that clamps created large tissue deformations in all three cases, regardless of design. This information could inform the development of new clamp designs and materials to minimise the potential for tissue damage.Level of evidence:4
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Affiliation(s)
- Joe Lemmens
- School of Health Sciences, University of Southampton, UK
| | - Lea Peko Cohen
- Department of Biomedical Engineering, Tel Aviv University, Israel
| | | | | | | | - Amit Gefen
- Department of Biomedical Engineering, Tel Aviv University, Israel
| | | | - Marcus Drake
- University of Bristol, Bristol Urological Institute, UK
| | | | - Mandy Fader
- School of Health Sciences, University of Southampton, UK
| | - Dan L Bader
- School of Health Sciences, University of Southampton, UK
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13
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Hong SK, Lee H. Focused ultrasound and prostate cancer. Ultrasonography 2020; 40:191-196. [PMID: 33138343 PMCID: PMC7994738 DOI: 10.14366/usg.20100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/01/2020] [Indexed: 11/25/2022] Open
Abstract
Focused ultrasound (FUS) has been utilized for the treatment of localized prostate cancer. Initially, FUS was performed as a whole-gland treatment comparable to radical prostatectomy or radiation therapy. However, after overall downward stage migration due to health screening programs involving prostate-specific antigen testing, as well as advances in conservative or observative strategies such as active surveillance, FUS has evolved from a whole-gland treatment to a focal treatment. This new treatment technique aims to ablate tumors while preserving the normal prostate tissue, thereby ensuring better preservation of urinary and erectile function. In this article, we review the mechanism and clinical outcomes of the FUS procedure.
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Affiliation(s)
- Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hakmin Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
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14
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Cinà IV, Di Sebastiano KM, Faulkner GE. "One stroke, with twenty-two people": exploring prostate cancer survivors' participation in dragon boating. J Psychosoc Oncol 2020; 38:375-388. [PMID: 32063129 DOI: 10.1080/07347332.2020.1725215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose: This study qualitatively explores prostate cancer survivors' experience in joining a dragon boating team and its possible impact on their wellbeing.Design: Qualitative data analysis.Sample: Eleven prostate cancer survivors from a dragon boat team.Methods: Semi-structured interviews and thematic analysis.Findings: The findings support physical benefits of dragon boating, however, the positive impact on the men's psychosocial wellbeing was more salient. Participation in dragon boating was important for establishing a social support system and positively reframing their cancer experience.Practice Implications: Dragon boating is a novel health promotion strategy for men with PC. Seeking to replicate the positive characteristics of dragon boating in the design of future physical activity interventions should be explored.
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Affiliation(s)
- Isabella V Cinà
- School of Kinesiology, The University of British Columbia, 210-6081 University Boulevard, Vancouver, Canada
| | - Katie M Di Sebastiano
- School of Kinesiology, The University of British Columbia, 210-6081 University Boulevard, Vancouver, Canada
| | - Guy E Faulkner
- School of Kinesiology, The University of British Columbia, 210-6081 University Boulevard, Vancouver, Canada
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15
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Turmel N, Ismael SS, Chesnel C, Charlanes A, Hentzen C, Le Breton F, Amarenco G. Use of a specific questionnaire and perineal electromyography to assess neuropathic pain after radical retropubic prostatectomy. Asian J Urol 2019; 6:364-367. [PMID: 31768323 PMCID: PMC6872839 DOI: 10.1016/j.ajur.2018.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/28/2017] [Accepted: 05/04/2018] [Indexed: 12/20/2022] Open
Abstract
Objective Prostate cancer is the most frequent cancer in men and radical retropubic prostatectomy (RRP) is one of the first-line treatment. However, RRP has some side effects and can lead to chronic perineal pain. The objective of the study was to determine in patients suffering from perineal pain after RRP the possibility of a neurogenic damage by means of a specific questionnaire dedicated to track down neuropathic pain. Methods Forty patients were explored by a specific and validated questionnaire, the Neuropathic Pain Symptom Inventory (NPSI). Patients were divided into two groups: Group A with an NSPI score ≥4 was considered as suffering from neuropathic pain, and Group B was considered as a control group without neuropathic pain (NSPI score <4). All patients had a perineal electrophysiological testing to confirm the possibility of a neurogenic damage. Results Group A was composed by 13 men and Group B by 27 men, with mean age 72.45 years and mean duration of pain 2.7 years. In Group A, the most frequent symptoms were burning sensation, electrical shock and numbness. Location of the pain was global perineal area (8/13), anus (10/13), penis (5/13) and glans penis (2/13). Electromyography (EMG) findings confirmed the presence of denervation and neurogenic damages compared with controls (p < 0.001). Conclusion One third of the patients consulting for chronic pain following RRP had probably a neuropathic lesion leading to a chronic perineal pain as suggested by an NSPI score ≥ 4 and EMG alterations.
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Affiliation(s)
- Nicolas Turmel
- Department of Neurourology, Tenon Hospital, GRC01 GREEN Group de Recherche Clinical Neurourology, Sorbonne University UPMC, Paris, France
| | - Samer Sheikh Ismael
- Department of Neurourology, Tenon Hospital, GRC01 GREEN Group de Recherche Clinical Neurourology, Sorbonne University UPMC, Paris, France
| | - Camille Chesnel
- Department of Neurourology, Tenon Hospital, GRC01 GREEN Group de Recherche Clinical Neurourology, Sorbonne University UPMC, Paris, France
| | - Audrey Charlanes
- Department of Neurourology, Tenon Hospital, GRC01 GREEN Group de Recherche Clinical Neurourology, Sorbonne University UPMC, Paris, France
| | - Claire Hentzen
- Department of Neurourology, Tenon Hospital, GRC01 GREEN Group de Recherche Clinical Neurourology, Sorbonne University UPMC, Paris, France
| | - Frédérique Le Breton
- Department of Neurourology, Tenon Hospital, GRC01 GREEN Group de Recherche Clinical Neurourology, Sorbonne University UPMC, Paris, France
| | - Gérard Amarenco
- Department of Neurourology, Tenon Hospital, GRC01 GREEN Group de Recherche Clinical Neurourology, Sorbonne University UPMC, Paris, France
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16
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Carrier J, Edwards D, Harden J. Men's perceptions of the impact of the physical consequences of a radical prostatectomy on their quality of life: a qualitative systematic review. ACTA ACUST UNITED AC 2019; 16:892-972. [PMID: 29634515 DOI: 10.11124/jbisrir-2017-003566] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To identify men's perceptions of the impact of the physical consequences of a radical prostatectomy on their quality of life. INTRODUCTION Prostate cancer is the most common male cancer and second most common cause of cancer death of men in the Western world. Compared to other prostate cancer treatments, trials report worse urinary incontinence and sexual function and similar bowel function among men with prostate-specific antigen detected prostate cancer who underwent radicalized prostatectomy. INCLUSION CRITERIA This review included men of all ages and nationalities who had undergone a radical prostatectomy as treatment for any stage of prostate cancer. It considered studies that investigated:Any setting where the topic was addressed with participants meeting the inclusion criteria was included. The review considered studies that focused on qualitative data including, but not limited to: phenomenology, grounded theory, ethnography and action research. Studies were included if they reported results relating to one or more of the phenomena of interest. Studies not written in English were excluded. METHODS The search strategy aimed to find published studies from six databases from database inception to November 2017. Methodological quality of studies was independently assessed by two reviewers using the standardized JBI Critical Appraisal Checklist for Qualitative Research. For data extraction, the standardized Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI) data extraction tool was used. A meta-aggregation was undertaken and the final synthesis of the findings was reached through discussion. Results are presented as five aggregated qualitative syntheses. RESULTS Nineteen qualitative studies were included in the review. The five synthesized findings were: CONCLUSIONS:: Urinary incontinence and erectile dysfunction are significant side-effects of radical prostatectomy which have a negative impact on men's quality of life for which they feel ill prepared, and physical and psychosocial support is essential.
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Affiliation(s)
- Judith Carrier
- The Wales Centre for Evidence Based Care: a Joanna Briggs Institute Centre of Excellence
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17
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Holze S, Mende M, Healy KV, Koehler N, Gansera L, Truss MC, Rebmann U, Degener S, Stolzenburg JU. Comparison of various continence definitions in a large group of patients undergoing radical prostatectomy: a multicentre, prospective study. BMC Urol 2019; 19:70. [PMID: 31345192 PMCID: PMC6659208 DOI: 10.1186/s12894-019-0500-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 07/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to the usage of various measurement methods and definitions, comparing continence rates after radical prostatectomy is a challenging task. This study compares continence rates based on different methods and aims to identify the definition for continence which agrees best with the patients' subjective assessment of continence. Additionally, continence was controlled for multiple influencing factors. METHODS This prospective multicentre study was carried out in seven hospitals throughout Germany. Before and at 3, 6, and 12 months after surgery self-reporting questionnaires were completed and returned by 329 (84.4%) of 390 eligible patients. The questionnaires were independently evaluated and analysed by a third party. Association of continence with demographic, operative, and tumour factors in an ongoing comprehensive prostate cancer database was evaluated. RESULTS The continence rate drops substantially for patients undergoing radical prostatectomy but increases again with time. Concrete numbers vary considerably depending on definition - 44% at 3 months and 68% at 12 months after surgery (0 pads) vs. 71 and 90% (0-1 pads). Significant confounding variables regarding continence rate are nerve-sparing procedure, categorized Gleason score, rehabilitative cure treatment, and pelvic floor training. The definition of 0 pads for continence coincides greater than 0-1 pads with the patients' self-assessment of being continent. CONCLUSION A standardized definition for continence would be desirable, as it is one of the most important preconditions to guarantee sound comparison of continence rates. Since there are enough other factors that make comparison difficult, we suggest using the definition of "0 pads". It is easily measured objectively, leaves no room for interpretation, and agrees best with the patients' self-assessment.
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Affiliation(s)
- Sigrun Holze
- Department of Urology, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
| | - Meinhard Mende
- Coordination Centre for Clinical Trials, University of Leipzig, Härtelstr. 16-18, 04107, Leipzig, Germany
| | - Karl V Healy
- Department of Urology, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Norbert Koehler
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany
| | - Lutz Gansera
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany
| | - Michael C Truss
- Department of Urology, Klinikum Dortmund, Beurhausstr. 40, 44137, Dortmund, Germany
| | - Udo Rebmann
- Department of Urology, Diakonissenkrankenhaus Dessau, Gropiusallee 3, 06846, Dessau, Germany
| | - Stephan Degener
- Department of Urology, Helios Klinikum Wuppertal, Heusnerstr. 40, 42283, Wuppertal, Germany
| | - Jens-Uwe Stolzenburg
- Department of Urology, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
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18
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Lemmens JM, Broadbridge J, Macaulay M, Rees RW, Archer M, Drake MJ, Moore KN, Bader DL, Fader M. Tissue response to applied loading using different designs of penile compression clamps. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2019; 12:235-243. [PMID: 31303800 PMCID: PMC6603992 DOI: 10.2147/mder.s188888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 03/22/2019] [Indexed: 12/02/2022] Open
Abstract
Background: Penile compression devices (PCD) or clamps are applied to compress the urethra and prevent urinary incontinence (UI). PCDs are more secure and less likely to leak than pads, allowing men the opportunity to participate in short-term, vigorous activities. However, they are uncomfortable, can cause pressure ulcers (PU) and affect penile blood flow. No objective assessment of tissue health has been undertaken to assess and compare different PCD designs and to provide guidance on safe use. Objective: This study was designed to evaluate existing PCDs in terms of their physiological response and potential for pressure-induced injury. Design, setting and participants: Six men with post-prostatectomy UI tested four selected PCDs at effective pressures, in a random order, in a controlled laboratory setting. Outcome measurements and statistical analysis: Using objective methods for assessing skin injury, PCDs were measured in situ for their effects on circulatory impedance, interface pressures and inflammatory response. Results and limitations: There was evidence for PCD-induced circulatory impedance in most test conditions. Interface pressures varied considerably between both PCDs and participants, with a mean value of 137.4±69.7 mmHg. In some cases, penile skin was noted to be sensitive to loading with elevated concentration of the cytokine IL-1α after 10 mins wear, indicating an inflammatory response. IL-1α levels were restored to baseline 40 mins following PCD removal. Conclusion: Skin health measures indicated tissue and blood flow compromise during the 50 mins of testing using all PCDs. Although there was an elevation in pro-inflammatory cytokines, PCDs did not cause sustained irritation and skin health measures recovered 40 mins after PCD removal. This research indicates that application of a clamp for one hour with an equal clamp free time before reapplication is likely to be safe. Longer periods are often recommended by manufacturers but have yet to be tested.
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Affiliation(s)
- Joseph Mh Lemmens
- University of Southampton, School of Health Sciences, Southampton SO17 1BJ, UK
| | - Jackie Broadbridge
- University of Southampton, School of Health Sciences, Southampton SO17 1BJ, UK
| | - Margaret Macaulay
- University of Southampton, School of Health Sciences, Southampton SO17 1BJ, UK
| | - Rowland W Rees
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Matt Archer
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Marcus J Drake
- Bristol Urological Institute, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Katherine N Moore
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Dan L Bader
- University of Southampton, School of Health Sciences, Southampton SO17 1BJ, UK
| | - Mandy Fader
- University of Southampton, School of Health Sciences, Southampton SO17 1BJ, UK
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Men's perceptions of the impact of the physical consequences of a radical prostatectomy on their quality of life. INT J EVID-BASED HEA 2019; 17 Suppl 1:S41-S42. [DOI: 10.1097/xeb.0000000000000192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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20
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Hodges P, Stafford R, Coughlin GD, Kasza J, Ashton-Miller J, Cameron AP, Connelly L, Hall LM. Efficacy of a personalised pelvic floor muscle training programme on urinary incontinence after radical prostatectomy (MaTchUP): protocol for a randomised controlled trial. BMJ Open 2019; 9:e028288. [PMID: 31061057 PMCID: PMC6502040 DOI: 10.1136/bmjopen-2018-028288] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Prostate cancer is the most common cancer in men. Prostatectomy is the most common treatment. Morbidity from prostatectomy is high-80% of men experience urinary incontinence which negatively impacts the quality of life. Postsurgical pelvic floor muscle training is commonly prescribed but recent systematic reviews found no evidence of efficacy. We propose a new treatment that commences preoperatively and targets functional training of specific pelvic floor muscles that contribute to urinary continence. Assessment and biofeedback using transperineal ultrasound imaging assists in training. This will be compared against conventional training (maximal pelvic floor muscle contraction assessed by digital rectal examination) and no training. Embedded physiological studies will allow the investigation of moderation and mediation of the treatment effect on the outcomes. METHODS AND ANALYSIS This randomised clinical trial will include 363 men scheduled to undergo radical prostatectomy for prostate cancer. Participants will be randomised into urethral training, conventional training and no training groups. Clinical data will be collected at baseline (1-2 weeks presurgery) and postsurgery after catheter removal, weekly to 3 months (primary endpoint) and monthly to 12 months. Outcomes include 24-hour pad weight test (primary), incontinence, quality of life and cost-effectiveness data. Neuromuscular control measures of pelvic floor muscles will be measured at baseline, postsurgery, 6 weeks, 3 and 12 months. Study assessors and statisticians will be blinded to the group allocation. ETHICS AND DISSEMINATION This study is registered with the Australian New Zealand Clinical Trials Registry and has ethical approval from the university and host hospital ethics committees. Trial outcomes will be shared via national/international conference presentations and peer-reviewed journal publications. TRIAL REGISTRATION NUMBER ACTRN12617000788370; Pre-results.
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Affiliation(s)
- Paul Hodges
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Ryan Stafford
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Geoff D Coughlin
- Renal Medicine, Royal Brisbane & Women’s Hospital, Brisbane, Queensland, Australia
- Wesley Urology Clinic, Wesley Hospital, Brisbane, Queensland, Australia
| | - Jessica Kasza
- Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - James Ashton-Miller
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Anne P Cameron
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Luke Connelly
- Centre for the Business and Economics of Health, University of Queensland, Brisbane, Queensland, Australia
- Poche Centre for Indigenous Health, University of Queensland, Brisbane, Queensland, Australia
| | - Leanne M Hall
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
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Bossio JA, Miller F, O'Loughlin JI, Brotto LA. Sexual Health Recovery For Prostate Cancer Survivors: The Proposed Role Of Acceptance And Mindfulness-Based Interventions. Sex Med Rev 2019; 7:627-635. [PMID: 31029619 DOI: 10.1016/j.sxmr.2019.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/22/2019] [Accepted: 03/07/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION 1 in every 7 Canadian men is affected by prostate cancer. Given impressive advances in detection, treatment, and survival rates, there is a considerable focus on survivors' supportive care needs. Among the top unmet supportive care needs for prostate cancer survivors are concerns related to sexual health and intimacy. AIM To provide a rationale for introducing mindfulness- and acceptance-based approaches into the role of psychosexual interventions aimed at improving sexual satisfaction among prostate cancer survivors (and their partners). METHODS A literature review was performed to examine the prevalence of sexual difficulties after prostate cancer treatment and the efficacy of current pharmacologic and psychological treatment approaches. MAIN OUTCOME MEASURE The main outcome measure was focused on sexual satisfaction in prostate cancer survivors. RESULTS Current pharmacologic interventions for sexual difficulties after prostate cancer treatment are not fully meeting the needs of prostate cancer survivors and their partners. Conclusions cannot be drawn from existing psychological interventions because of methodologic inconsistencies. Additionally, the focus on erectile function as a measure of treatment effectiveness is likely to instill a greater sense of hopelessness and loss for prostate cancer survivors, which may exacerbate issues around sexual intimacy and satisfaction. An impressive body of evidence supports the role of mindfulness in improving women's sexual functioning and there is preliminary evidence suggesting the efficacy of this approach for improving men's sexual functioning. CONCLUSION We propose that psychosexual interventions that prioritize mindfulness and acceptance-based frameworks may help men to tune into sensations while challenging the foci on performance and erections, thereby increasing the potential for improvement to sexual satisfaction among prostate cancer survivors. Bossio JA, Miller F, O'Loughlin JI, et al. Sexual Health Recovery for Prostate Cancer Survivors: The Proposed Role of Acceptance and Mindfulness-Based Interventions. Sex Med Rev 2019;7:627-635.
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Affiliation(s)
- Jennifer A Bossio
- Queen's University, Departments of Gynecology, and Urology, Kingston, Ontario, Canada
| | - Faith Miller
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Lori A Brotto
- University of British Columbia, Vancouver, British Columbia, Canada.
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22
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Novel Mapping Method for the Intraoperative Neurophysiologic Monitoring of Sexual Function During Prostate Surgery. J Clin Neurophysiol 2018; 35:463-467. [DOI: 10.1097/wnp.0000000000000506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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23
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Romanzini AE, Pereira MDG, Guilherme C, Cologna AJ, de Carvalho EC. Predictors of well-being and quality of life in men who underwent radical prostatectomy: longitudinal study1. Rev Lat Am Enfermagem 2018; 26:e3031. [PMID: 30183870 PMCID: PMC6136529 DOI: 10.1590/1518-8345.2601.3031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/06/2018] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE to identify socio-demographic, clinical and psychological predictors of well-being and quality of life in men who underwent radical prostatectomy, in a 360-day follow-up. METHOD longitudinal study with 120 men who underwent radical prostatectomy. Questionnaires were used for characterization and clinical evaluation of the participant, as well as the instruments Visual Analog Scale for Pain, The Ways of Coping Questionnaire, Hospital Depression and Anxiety Scale, Satisfaction with Social Support Scale, Marital Satisfaction Scale, Subjective Well-Being Scale and Expanded Prostate Cancer Index. For data analysis, the linear mixed-effects model was used. RESULTS the socio-demographic factors age and race were not predictors of the dependent variables; time of surgery, problem-focused coping, and anxiety were predictors of subjective well-being; pain, anxiety and depression were negative predictors of quality of life; emotion-focused coping was a positive predictor. Marital dissatisfaction was a predictor of both variables. CONCLUSION predictor variables found were different from the literature: desire for changes in marital relationship presented a positive association with quality of life and well-being; emotion-focused coping was a predictor of quality of life; and anxiety was a predictor of subjective well-being.
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Affiliation(s)
| | | | - Caroline Guilherme
- PhD, Adjunct Professor, Curso de Enfermagem e Obstetrícia,
Universidade Federal do Rio de Janeiro, Macaé, RJ, Brazil
| | - Adauto José Cologna
- PhD, Senior Professor, Faculdade de Medicina de Ribeirão Preto,
Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Emilia Campos de Carvalho
- PhD, Senior Professor, Escola de Enfermagem de Ribeirão Preto,
Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research
Development, Ribeirão Preto, SP, Brazil
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Grondhuis Palacios LA, Krouwel EM, den Oudsten BL, den Ouden MEM, Kloens GJ, van Duijn G, Putter H, Pelger RCM, Elzevier HW. Suitable sexual health care according to men with prostate cancer and their partners. Support Care Cancer 2018; 26:4169-4176. [PMID: 29876833 PMCID: PMC6209012 DOI: 10.1007/s00520-018-4290-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 05/23/2018] [Indexed: 10/25/2022]
Abstract
PURPOSE To determine which health care provider and what timing is considered most suitable to discuss sexual and relational changes after prostate cancer treatment according to the point of view of men and their partners. METHODS A cross-sectional survey was conducted among men diagnosed with prostate cancer or treated after active surveillance, who received laparoscopic radical prostatectomy, brachytherapy, intensity-modulated radiotherapy, and/or hormonal therapy. If applicable, partners were included as well. RESULTS In this survey, 253 men and 174 partners participated. Mean age of participating men was 69.3 years (SD 6.9, range 45-89). The majority (77.8%) was married and average length of relationship was 40.3 years (SD 14.1, range 2-64). Out of 250 men, 80.5% suffered from moderate to severe erectile dysfunction. Half of them (50.2%, n = 101) was treated for erectile dysfunction and great part was partially (30.7%, n = 31) up to not satisfied (25.7%, n = 26). Half of the partners (50.6%, n = 81) found it difficult to cope with sexual changes. A standard consultation with a urologist-sexologist to discuss altered sexuality is considered preferable by 74.7% (n = 183). Three months after treatment was the most suitable timing according to 47.6% (n = 49). CONCLUSIONS During follow-up consultations, little attention is paid to the impact of treatment-induced sexual dysfunction on the relationship of men with prostate cancer and their partners. A standard consultation with a urologist-sexologist 3 months after treatment to discuss sexual and relational issues is considered as most preferable.
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Affiliation(s)
| | - Esmée M Krouwel
- Department of Urology, Leiden University Medical Center, PO Box 9600, 2300 WB, Leiden, The Netherlands
| | - Brenda L den Oudsten
- Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands
| | - Marjolein E M den Ouden
- Research Center of Nursing, Saxion University of Applied Sciences, PO Box 70000, 7500 KB, Enschede, The Netherlands
| | - Gert Jan Kloens
- Department of Psychology, Education & Child Studies, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Grethe van Duijn
- Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands
| | - Hein Putter
- Department of Medical Statistics, Leiden University Medical Center, PO Box 9600, 2300 WB, Leiden, The Netherlands
| | - Rob C M Pelger
- Department of Urology, Leiden University Medical Center, PO Box 9600, 2300 WB, Leiden, The Netherlands
| | - Henk W Elzevier
- Department of Urology, Leiden University Medical Center, PO Box 9600, 2300 WB, Leiden, The Netherlands
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Manso M, Alexandre B, Antunes-Lopes T, Martins-da-Silva C, Cruz F. Is the adjustable transobturator system ATOMS® useful for the treatment of male urinary incontinence in low to medium volume urological centers? Actas Urol Esp 2018; 42:267-272. [PMID: 29174630 DOI: 10.1016/j.acuro.2017.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 07/03/2017] [Accepted: 07/04/2017] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Urinary incontinence (UI) is a complication of radical prostatectomy (RP) and transurethral resection of the prostate (TURP). The gold-standard treatment is the artificial urinary sphincter, however, new treatments have been investigated. OBJECTIVE To examine the outcome of an adjustable transobturator male system (ATOMS®) in men with UI after prostatic surgery in a low to medium volume continence center. MATERIALS AND METHODS Twenty-five men with UI were implanted with ATOMS® system between 2012 and 2014. The most common indication was UI after RP (92%), followed by UI after TURP (8%). Eleven patients (44%) had received adjuvant external beam radiotherapy (RT). Patients were considered to be 'dry' if they stopped wearing pads or needed just one protective pad per day; and improved if the daily number of pads used decreased by at least half. The Incontinence Quality of Life questionnaire (ICIQ-SF) was used, adding a verbal question about the satisfaction of the patient considering the outcome. RESULTS After a mean follow-up of 21.56 months, 64% were dry and 8% revealed a significant improvement. The success of the procedure was negatively correlated with the severity of the previous UI and with previous treatment with RT. Concerning patients satisfaction, 84% of the patients would repeat the procedure. CONCLUSION ATOMS® offers good rates of cure and improvement of UI after prostatic surgery with a reasonable rate of minor complications. The results of this study, performed in a low to medium volume continence center, are comparable to the results achieved in high volume continence centers.
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Affiliation(s)
- M Manso
- Urology Department, Centro Hospitalar São João, Porto, Portugal.
| | - B Alexandre
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - T Antunes-Lopes
- Urology Department, Centro Hospitalar São João, Porto, Portugal; i3S Institute for Innovation and Health Research, Porto, Portugal
| | - C Martins-da-Silva
- Urology Department, Centro Hospitalar São João, Porto, Portugal; Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - F Cruz
- Urology Department, Centro Hospitalar São João, Porto, Portugal; Faculdade de Medicina, Universidade do Porto, Porto, Portugal; i3S Institute for Innovation and Health Research, Porto, Portugal
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Bessaoud F, Orsini M, Iborra F, Rebillard X, Faix A, Soulier M, Daurès JP, Trétarre B. [Urinary incontinence and sexual dysfunction after treatment of localized prostate cancer: Results from a population aged less than 65years old]. Bull Cancer 2016; 103:829-840. [PMID: 27692730 DOI: 10.1016/j.bulcan.2016.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/31/2016] [Accepted: 09/07/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION An increasing number of patients with prostate cancer (PC) are diagnosed and treated. The aim of this study was to investigate urinary incontinence (UI) and sexual dysfunction (SD) two years after treatment for localized prostate cancer (PC). METHODS This study followed all cases of localized PC diagnosed between 2008 and 2009 in men aged≤65years old and still alive two years after treatment. In total, 437 men were recruited. Data were collected using a standardized questionnaire and by cross-checking with data from the cancer registry. Descriptive and comparative analyses were performed to evaluate persisting UI and SD at 2years. RESULTS At two years after treatment, UI was persistent in 48.8%; 41.2% had used urinary protections, and 39.2% had used at least 1 pad/day; 55.2% reported financial difficulties for purchasing protective pads. In total, 22.7% did not consult a specialist for UI. SD was persistent in 82.8%; 30.4% did not consult a specialist for SD. SD had a negative impact on the sex life of patients and their partners. After adjustment for cancer stage, prostatectomy was significantly associated with persisting UI and SD at two years. CONCLUSION Two years after treatment, rates of persisting UI and/or SD remain high. Treatment by prostatectomy was significantly associated with an increased risk of persisting adverse effects at two years. The different toxicities between treatments should be presented to patients before initiating therapy in order to encourage the patient to contributed to shared treatment decision-making.
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Affiliation(s)
- Faïza Bessaoud
- Registre des tumeurs de l'Hérault, 208, avenue des apothicaires, 34298 Montpellier, France.
| | - Mattéa Orsini
- Institut universitaire de recherche clinique (IURC), 641, avenue du Doyen-Gaston-Giraud, 34093 Montpellier cedex, France
| | - François Iborra
- Centre hospitalo-universitaire, hôpital Lapeyronie, service d'urologie, 345, rue du Muscadet, 34090 Montpellier, France
| | - Xavier Rebillard
- Clinique Beau-Soleil, service d'urologie, 119, rue de Lodève, 34070 Montpellier, France
| | - Antoine Faix
- Clinique Beau-Soleil, service d'urologie, 119, rue de Lodève, 34070 Montpellier, France
| | - Maryvonne Soulier
- Centre régional de lutte contre le cancer (CRLCC), 208, avenue des Apothicaires, 34298 Montpellier, France
| | - Jean-Pierre Daurès
- Institut universitaire de recherche clinique (IURC), 641, avenue du Doyen-Gaston-Giraud, 34093 Montpellier cedex, France
| | - Brigitte Trétarre
- Registre des tumeurs de l'Hérault, 208, avenue des apothicaires, 34298 Montpellier, France
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Hsu LF, Liao YM, Lai FC, Tsai PS. Beneficial effects of biofeedback-assisted pelvic floor muscle training in patients with urinary incontinence after radical prostatectomy: A systematic review and metaanalysis. Int J Nurs Stud 2016; 60:99-111. [PMID: 27297372 DOI: 10.1016/j.ijnurstu.2016.03.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 03/16/2016] [Accepted: 03/18/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This systematic review and metaanalysis compared the effects of biofeedback-assisted pelvic floor muscle training with those of pelvic floor muscle training alone in patients with urinary incontinence after radical prostetactomy. DESIGN A review and metaanalysis study design. DATA SOURCES The metaanalysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and MetaAnalyses guidelines. A systematic search of PubMed/Medline OVID, the Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, BioMed Central, Web of Science, Chinese Electronic Periodical Services, Chinese Journal and Thesis Database, and China National Knowledge Infrastructure was performed for retrieving records. REVIEW METHODS For determining the effects of training type on urinary incontinence, randomized controlled trials on biofeedback-assisted pelvic floor muscle training with or without electrical stimulation were compared with those on pelvic floor muscle training with or without electrical stimulation, respectively, in the metaanalysis. The Cochrane Collaboration tool in the Cochrane Handbook for Systematic Review of Interventions 5.1.0 was used to assess the methodological quality of the included trials. Subjective and objective measurement of urinary incontinence improvement and the quality of life were the primary and secondary outcome measures, respectively. Data were analyzed using Comprehensive Meta-Analysis software 2.0. In addition, subgroup analyses and metaregression were performed to explore the possible sources of heterogeneity. RESULTS Thirteen randomized controlled trials involving 1108 patients with prostatectomy incontinence were included. The immediate-, intermediate-, and long-term effects of objectively measured biofeedback-assisted pelvic floor muscle training on urinary incontinence were significant (mean effect size=-0.316, -0.335, and -0.294; 95% CI: -0.589 to -0.043, -0.552 to -0.118 and -0.535 to -0.053; p=0.023, 0.002, and 0.017, respectively) when compared with those of pelvic floor muscle training alone. However, when urinary incontinence was measured subjectively, only the intermediate and long-term effects of biofeedback were found (p=0.034 and 0.005, respectively). Small-to-moderate immediate- and intermediate-term effects on the quality of life were observed when biofeedback-assisted pelvic floor muscle training was compared with pelvic floor muscle training alone. No publication bias was observed among studies. CONCLUSIONS Biofeedback can be an adjunct treatment to pelvic floor muscle training for reducing urinary incontinence in patients who have undergone radical prostatectomy.
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Affiliation(s)
- Lan-Fang Hsu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Yuan-Mei Liao
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Fu-Chih Lai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Pei-Shan Tsai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Sleep Science Center, Taipei Medical University Hospital, Taipei, Taiwan.
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Morgan L, Carrier J, Edwards D. Menʼs perceptions of the impact of the physical consequences of radical prostatectomy on their quality of life: a qualitative systematic review protocol. ACTA ACUST UNITED AC 2015; 13:37-46. [DOI: 10.11124/jbisrir-2015-2408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 08/04/2015] [Accepted: 10/07/2015] [Indexed: 10/31/2022]
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Lin Y, Lin WC, Fwu PT, Shih TC, Yeh LR, Su MY, Chen JH. Investigation of factors affecting hypothermic pelvic tissue cooling using bio-heat simulation based on MRI-segmented anatomic models. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2015; 122:76-88. [PMID: 26198131 PMCID: PMC4549219 DOI: 10.1016/j.cmpb.2015.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 06/08/2015] [Accepted: 07/03/2015] [Indexed: 06/11/2023]
Abstract
This study applied a simulation method to map the temperature distribution based on magnetic resonance imaging (MRI) of individual patients, and investigated the influence of different pelvic tissue types as well as the choice of thermal property parameters on the efficiency of endorectal cooling balloon (ECB). MR images of four subjects with different prostate sizes and pelvic tissue compositions, including fatty tissue and venous plexus, were analyzed. The MR images acquired using endorectal coil provided a realistic geometry of deformed prostate that resembled the anatomy in the presence of ECB. A single slice with the largest two-dimensional (2D) cross-sectional area of the prostate gland was selected for analysis. The rectal wall, prostate gland, peri-rectal fatty tissue, peri-prostatic fatty tissue, peri-prostatic venous plexus, and urinary bladder were manually segmented. Pennes' bioheat thermal model was used to simulate the temperature distribution dynamics, by using an in-house finite element mesh based solver written in MATLAB. The results showed that prostate size and periprostatic venous plexus were two major factors affecting ECB cooling efficiency. For cases with negligible amount of venous plexus and small prostate, the average temperature in the prostate and neurovascular bundles could be cooled down to 25 °C within 30 min. For cases with abundant venous plexus and large prostate, the temperature could not reach 25 °C at the end of 3 h cooling. Large prostate made the cooling difficult to propagate through. The impact of fatty tissue on cooling effect was small. The filling of bladder with warm urine during the ECB cooling procedure did not affect the temperature in the prostate or NVB. In addition to the 2D simulation, in one case a 3D pelvic model was constructed for volumetric simulation. It was found that the 2D slice with the largest cross-sectional area of prostate had the most abundant venous plexus, and was the most difficult slice to cool, thus it may provide a conservative prediction of the cooling effect. This feasibility study demonstrated that the simulation tool could potentially be used for adjusting the setting of ECB for individual patients during hypothermic radical prostatectomy. Further studies using MR thermometry are required to validate the in silico results obtained using simulation.
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Affiliation(s)
- Yuting Lin
- Tu and Yuen Center for Functional Onco-Imaging of Department of Radiological Sciences, University of California, Irvine, CA 92697, USA
| | - Wei-Ching Lin
- Department of Radiology, China Medical University Hospital, Taichung 40402, Taiwan
| | - Peter T Fwu
- Tu and Yuen Center for Functional Onco-Imaging of Department of Radiological Sciences, University of California, Irvine, CA 92697, USA
| | - Tzu-Ching Shih
- Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung 40402, Taiwan
| | - Lee-Ren Yeh
- Department of Radiology, E-Da Hospital and I-Shou University, Kaohsiung 82445, Taiwan
| | - Min-Ying Su
- Tu and Yuen Center for Functional Onco-Imaging of Department of Radiological Sciences, University of California, Irvine, CA 92697, USA
| | - Jeon-Hor Chen
- Tu and Yuen Center for Functional Onco-Imaging of Department of Radiological Sciences, University of California, Irvine, CA 92697, USA; Department of Radiology, E-Da Hospital and I-Shou University, Kaohsiung 82445, Taiwan.
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Elliott (nee Murray) KEJ, Scott JL, Monsour M, Nuwayhid F. Profiles of dyadic adjustment for advanced prostate cancer to inform couple-based intervention. Psychol Health 2015; 30:1259-73. [DOI: 10.1080/08870446.2015.1043301] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Macaulay M, Broadbridge J, Gage H, Williams P, Birch B, Moore KN, Cottenden A, Fader MJ. A trial of devices for urinary incontinence after treatment for prostate cancer. BJU Int 2015; 116:432-42. [PMID: 25496354 DOI: 10.1111/bju.13016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To compare the performance of three continence management devices and absorbent pads used by men with persistent urinary incontinence (>1 year) after treatment for prostate cancer. PATIENTS AND METHODS Randomised, controlled trial of 56 men with 1-year follow-up. Three devices were tested for 3 weeks each: sheath drainage system, body-worn urinal (BWU) and penile clamp. Device and pad performance were assessed. Quality of life (QoL) was measured at baseline and follow-up with the King's Health Questionnaire. Stated (intended use) and revealed (actual use) preference for products were assessed. Value-for-money was gathered. RESULTS Substantial and significant differences in performance were found. The sheath was rated as 'good' for extended use (e.g. golf and travel) when pad changing is difficult; for keeping skin dry, not leaking, not smelling and convenient for storage and travel. The BWU was generally rated worse than the sheath and was mainly used for similar activities but by men who could not use a sheath (e.g. retracted penis) and was not good for seated activities. The clamp was good for short vigorous activities like swimming/exercise; it was the most secure, least likely to leak, most discreet but almost all men described it as uncomfortable or painful. The pads were good for everyday activities and best for night-time use; most easy to use, comfortable when dry but most likely to leak and most uncomfortable when wet. There was a preference for having a mixture of products to meet daytime needs; around two-thirds of men were using a combination of pads and devices after testing compared with baseline. CONCLUSIONS This is the first trial to systematically compare different continence management devices for men. Pads and devices have different strengths, which make them particularly suited to certain circumstances and activities. Most men prefer to use pads at night but would choose a mixture of pads and devices during the day. Device limitations were important but may be overcome by better design.
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Affiliation(s)
- Margaret Macaulay
- Continence and Skin Technology Group, University College London, London, UK
| | - Jackie Broadbridge
- Department of Economics, University of Surrey, Guildford, UK.,Continence and Skin Technology Group, University of Southampton, Southampton, UK
| | - Heather Gage
- Department of Economics, University of Surrey, Guildford, UK
| | - Peter Williams
- Department of Mathematics, University of Surrey, Guildford, UK
| | - Brian Birch
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Alan Cottenden
- Continence and Skin Technology Group, University College London, London, UK
| | - Mandy J Fader
- Continence and Skin Technology Group, University of Southampton, Southampton, UK
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Lassen B, Gattinger H, Saxer S. A systematic review of physical impairments following radical prostatectomy: effect of psychoeducational interventions. J Adv Nurs 2013; 69:2602-12. [PMID: 23782275 DOI: 10.1111/jan.12186] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2013] [Indexed: 11/28/2022]
Abstract
AIMS To determine the effect of psychoeducational interventions on urinary and faecal incontinence and erectile dysfunction in men 50 years and older after prostatectomy for prostate cancer in comparison to usual care. BACKGROUND Prostate cancer is the second most frequently diagnosed cancer in men worldwide. The major complications of radical prostatectomy are urinary and faecal incontinence as well as sexual dysfunction, associated with significantly reduced quality of life. DESIGN A systematic review of randomized controlled trials was undertaken to provide a narrative synthesis and critical appraisal of included studies. DATA SOURCES The electronic databases MEDLINE and CINAHL were searched using a systematic search strategy for studies published between January 2001-December 2012. In addition, reference lists of included papers were checked. The Cochrane Database was screened for whether a review on this topic already exists. REVIEW METHODS The systematic review included randomized controlled trials in men after prostate cancer treatment and psychoeducational interventions to influence urinary or faecal incontinence and erectile dysfunction. The quality of studies was assessed by the reviewers using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method. RESULTS Eight trials met the inclusion criteria. Although these studies are heterogeneous and of varied quality, a descriptive synthesis of results suggests that psychoeducational interventions may improve urinary incontinence, bowel bother, sexual function and sexual bother to some extent. CONCLUSION The results of this systematic review indicate that it would be worthwhile to implement postprostatectomy psychoeducational interventions into nursing discharge planning. Future research is necessary to corroborate these results and define the most favourable time to implement psychoeducational interventions.
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Affiliation(s)
- Britta Lassen
- Institute of Applied Nursing Science IPW-FHS, University of Applied Sciences St. Gallen, Switzerland
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Collinge W, Kahn J, Walton T, Kozak L, Bauer-Wu S, Fletcher K, Yarnold P, Soltysik R. Touch, Caring, and Cancer: randomized controlled trial of a multimedia caregiver education program. Support Care Cancer 2012; 21:1405-14. [PMID: 23262808 PMCID: PMC3612588 DOI: 10.1007/s00520-012-1682-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 11/27/2012] [Indexed: 11/24/2022]
Abstract
Purpose A randomized controlled trial was conducted to evaluate outcomes of a multimedia instructional program for family caregivers in simple touch-based techniques to provide comfort to cancer patients at home. Methods A multilingual 78-min DVD and 66-page manual were produced for homebased instruction. Content addresses attitudes and communication about touch in cancer, psychological preparation for giving and receiving touch, safety precautions, massage techniques for comfort and relaxation, acupressure for specific cancer-related symptoms, and practice in the home setting. Materials were produced in English, Spanish, and Chinese versions. A community-based multiethnic sample of 97 adult patient/caregiver dyads was randomized to experimental (massage) or attention control (reading) groups for 4 weeks. Massage dyads received the program and instructions to practice at least three times per week, while control caregivers read to their patients for the same frequency. Self-report instruments assessed change in symptom severity, quality of life, perceived stress, and caregiver attitudes. Results Significant reductions in all symptoms occurred for patients after both activities: 12–28 % reductions after reading vs. 29–44 % after massage. Massage caregivers showed significant gains in confidence, comfort, and self-efficacy using touch and massage as forms of caregiving. Conclusions Multimedia instruction in touch and massage methods may offer family members a viable means of enhancing self-efficacy and satisfaction in caregiving while decreasing patient pain, depression, and other symptoms. Family members may be able to learn and apply safe and simple methods that increase patient comfort and reduce distress.
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Zopf EM, Braun M, Machtens S, Zumbé J, Bloch W, Baumann FT. Implementation and scientific evaluation of rehabilitative sports groups for prostate cancer patients: study protocol of the ProRehab Study. BMC Cancer 2012; 12:312. [PMID: 22827935 PMCID: PMC3414755 DOI: 10.1186/1471-2407-12-312] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 07/06/2012] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although treatment regimen have improved in the last few years, prostate cancer patients following a radical prostatectomy still experience severe disease- and treatment-related side effects, including urinary incontinence, erectile dysfunction and psychological issues. Despite high incidence rates and the common adverse effects there is a lack of supportive measures for male patients and specific physical exercise recommendations for prostate cancer patients during rehabilitation or in the aftercare are still missing. METHODS/DESIGN The ProRehab Project aims to establish rehabilitative sports groups particularly for prostate cancer patients and to evaluate the effects of the offered exercise program. Starting 8-12 weeks after prostatectomy or combination therapy, prostate cancer patients will exercise for 15 months within a patient preference randomized controlled trial. One exercise session will be conducted within a pre-established rehabilitative sports group, while the other will be completed independently. Patients in the control group will not participate in the intervention. The main outcomes of the study include aerobic fitness, quality of life, incontinence and erectile dysfunction. DISCUSSION By combining science, practice, and public relations the first rehabilitative sports groups for prostate cancer patients in Germany have been set up and thus contribute to the care structure for prostate cancer patients. By offering a 15-month physical exercise intervention that is conducted in supervised group sessions, long-term lifestyle changes and therefore improvements in quality of life in prostate cancer patients can be expected. TRIAL REGISTRATION German Clinical Trials Register DRKS00004184.
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Affiliation(s)
- Eva M Zopf
- Institute of Cardiovascular Research and Sport Medicine, Department of Molecular and Cellular Sport Medicine, German Sport University Cologne, Am Sportpark Müngersdorf 6, Cologne, 50933, Germany
| | - Moritz Braun
- Heilig-Geist-Hospital Cologne-Longerich, Graseggerstr. 105, Cologne-Longerich, 50737, Germany
| | - Stefan Machtens
- Marien Hospital Bergisch Gladbach, Dr.-Robert-Koch-Str. 18, Bergisch Gladbach, 51465, Germany
| | - Jürgen Zumbé
- Clinical Centre Leverkusen, Am Gesundheitspark 11, Leverkusen, 51375, Germany
| | - Wilhelm Bloch
- Institute of Cardiovascular Research and Sport Medicine, Department of Molecular and Cellular Sport Medicine, German Sport University Cologne, Am Sportpark Müngersdorf 6, Cologne, 50933, Germany
| | - Freerk T Baumann
- Institute of Cardiovascular Research and Sport Medicine, Department of Molecular and Cellular Sport Medicine, German Sport University Cologne, Am Sportpark Müngersdorf 6, Cologne, 50933, Germany
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Nilssen SR, Mørkved S, Overgård M, Lydersen S, Angelsen A. Does physiotherapist-guided pelvic floor muscle training increase the quality of life in patients after radical prostatectomy? A randomized clinical study. ACTA ACUST UNITED AC 2012; 46:397-404. [PMID: 22746358 DOI: 10.3109/00365599.2012.694117] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to study the effect of postoperative physiotherapist-guided pelvic floor muscle training (PFMT) on health-related quality of life (HRQoL) parameters in patients treated with radical prostatectomy (RP). MATERIAL AND METHODS A prospective randomized controlled trial was conducted at St. Olavs Hospital, Trondheim University Hospital, Norway. Eighty-five men were randomized into two intervention groups (A and B). patients in group A (n = 42) were offered physiotherapist-guided PFMT (in groups or by DVD) once weekly throughout the first 12 months after RP, while those in group B (n = 43) trained on their own. HRQoL data were assessed using the University of California, Los Angeles Prostate Cancer Index (UCLA-PCI) and the Short Form-12 (SF-12) health survey. The physical component summary (PCS) and mental component summary (MCS) scores of the SF-12 plus the urinary, sexual and bowel function and bother of the UCLA-PCI make up the eight quality of life outcomes used in this study. Data were obtained preoperatively (baseline), 6 weeks, and 3, 6 and 12 months postoperatively. RESULTS Eighty patients completed at least one follow-up assessment, 38 in group A and 42 in group B, giving a dropout rate of 5.9%. The overall response rates were 96% at baseline, 83% at 6 weeks, 90% at 3 months, 88% at 6 months and 68% at 12 months. No statistically significant difference in HRQoL was found between groups A and B. CONCLUSIONS Even though physiotherapist-guided training of the pelvic floor muscles after RP improved postoperative urinary incontinence significantly compared to those patients receiving standard care/training, this was not reflected in better outcome in HRQoL parameters.
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Affiliation(s)
- Steffan Robstad Nilssen
- Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Abstract
PURPOSE OF REVIEW Much of the progress in improving potency outcomes after radical prostatectomy has been achieved due to a better visualization of the neurovascular bundle responsible for erectile function. We review the current literature evaluating the existing imaging modalities to image the neurovascular bundle around the prostate pre, intra, and postoperatively, thereby enabling development of surgical techniques for better preservation of nerve function. RECENT FINDINGS Imaging modalities like multiphoton microscopy, optical coherence tomography, Coherent anti-Raman spectroscopy, exogenous fluoroscopy using prostate-specific membrane antigen, and so on have led to a better appreciation of the neurovascular bundle, thus encouraging novel techniques in nerve preservation during radical prostatectomy. SUMMARY In an age of heightened patient expectations and increasing life expectancy, better visualization of the neurovascular bundle around the prostate using novel imaging modalities may provide breakthroughs in improving potency outcomes after radical prostatectomy.
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Smyth LG, Cullen IM, Quinlan DM. Pursuit of sexual function post-radical prostatectomy. Can Urol Assoc J 2012; 7:E183-9. [PMID: 22277629 DOI: 10.5489/cuaj.10192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In the event of the implementation of prostate cancer screening, younger men will be diagnosed more frequently. Erectile dysfunction (ED) is a frequent long-term complication in men post-radical prostatectomy (RP). Since the introduction of RP, urologists have strived to improve postoperative sexual function. There is little literature, however, in the area of ED prescribing and sexual pursuit in men post-RP. We assessed the pursuit of sexual function in this group of patients. METHODS The study involved a detailed questionnaire sent to patients who have undergone radical retropublic prostatectomy (RRP) by one surgeon in one institution to ascertain the impact of ED on lifestyle and ED therapy prescription use. RESULTS There was a response rate of 59%; most patients who responded were in the 61 to 70 year age group at the time of the survey. About 25% of patients had intercourse more than once in the 4 weeks prior to the survey. A total 50% of patients had no problem or a very small problem with their sexual function. Overall 80% of patients were prescribed ED therapy, but less than 35% of them used it. CONCLUSION Sexual frequency peaked in younger patients who were 3 years or more from surgery. Of note, 46% of men either declined the offer of ED therapy or got the prescription and never used it. Only 34% of men had used their ED prescription in the last 4 weeks. Urologists frequently find that patients behave differently postoperatively, with less interest in sexual activity. Interestingly, we found that 50% of our patients classified their sexual function, as at most a small problem.
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Affiliation(s)
- Lisa G Smyth
- Department of Urology, St. Vincent's University Hospital, Dublin, Ireland
| | - Ivor M Cullen
- Department of Urology, St. Vincent's University Hospital, Dublin, Ireland
| | - David M Quinlan
- Department of Urology, St. Vincent's University Hospital, Dublin, Ireland
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Tewari AK, Srivastava A, Huang MW, Robinson BD, Shevchuk MM, Durand M, Sooriakumaran P, Grover S, Yadav R, Mishra N, Mohan S, Brooks DC, Shaikh N, Khanna A, Leung R. Anatomical grades of nerve sparing: a risk-stratified approach to neural-hammock sparing during robot-assisted radical prostatectomy (RARP). BJU Int 2011; 108:984-92. [PMID: 21917101 DOI: 10.1111/j.1464-410x.2011.10565.x] [Citation(s) in RCA: 145] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES • To report the potency and oncological outcomes of patients undergoing robot-assisted radical prostatectomy (RARP) using a risk-stratified approach based on layers of periprostatic fascial dissection. • We also describe the surgical technique of complete hammock preservation or nerve sparing grade 1. PATIENTS AND METHODS • This is a retrospective study of 2317 patients who had robotic prostatectomy by a single surgeon at a single institution between January 2005 and June 2010. • Included patients were those with ≥ 1 year of follow-up and who were potent preoperatively, defined as having a sexual health inventory for men (SHIM) questionnaire score of >21; thus, the final number of patients in the study cohort was 1263. • Patients were categorized pre-operatively by a risk-stratified approach into risk grades 1-4, where risk grade 1 patients received nerve-sparing grade 1 or complete hammock preservation and so on for risk grades 2-4, as long as intraoperative findings permitted the planned nerve sparing. • We considered return to sexual function post-operatively by two criteria: i) ability to have successful intercourse (score of ≥ 4 on question 2 of the SHIM) and ii) SHIM >21 or return to baseline sexual function. RESULTS • There was a significant difference across different NS grades in terms of the percentages of patients who had intercourse and returned to baseline sexual function (P < 0.001), with those that underwent NS grade 1 having the highest rates (90.9% and 81.7%) as compared to NS grades 2 (81.4% and 74.3%), 3 (73.5% and 66.1%), and 4 (62% and 54.5%). • The overall positive surgical margin (PSM) rates for patients with NS grades 1, 2, 3, and 4 were 9.9%, 8.1%, 7.2%, and 8.7%, respectively (P = 0.636). • The extraprostatic extension rates were 11.6%, 14.3%, 29.3%, and 36.2%, respectively (P < 0.001). • Similarly, in patients younger than 60, intercourse and return to baseline sexual function rates were 94.9% and 84.3% for NS grade 1 as compared to 85.5% and 77.2% for NS grades 2, 76.9% and 69% for NS grades 3, and 64.8% and 57.7% for NS Grade 4 (P < 0.001). CONCLUSIONS • The risk-stratified approach and anatomical technique of neural-hammock sparing described in the present manuscript was effective in improving potency outcomes of patients without compromising cancer control. • Patients with greater degrees of NS had higher rates of intercourse and return to baseline sexual function without an increase in PSM rates.
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Affiliation(s)
- Ashutosh K Tewari
- LeFrak Institute of Robotic Surgery and Prostate Cancer Institute, James Buchanan Brady Foundation Department of Urology, Weill Medical College of Cornell University, New York, NY 10065, USA.
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Steinsvik EAS, Axcrona K, Dahl AA, Eri LM, Stensvold A, Fosså SD. Can sexual bother after radical prostatectomy be predicted preoperatively? Findings from a prospective national study of the relation between sexual function, activity and bother. BJU Int 2011; 109:1366-74. [PMID: 21999333 DOI: 10.1111/j.1464-410x.2011.10598.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
UNLABELLED What's known on the subject? And what does the study add? Sexual function is often impaired after radical prostatectomy resulting in reduced sexual activity and sexual bother. The main focus in the literature concerning sexual adverse effects has been on erectile dysfunction and impairment of sexual function rather than the actual sexual bother it causes, although the sexual bother is most important to the individual patient's quality of life. The relation between these measures, and in particular preoperative prediction of postoperative sexual bother, has only been studied in a limited way and with varying results. Some studies have found good mental health, low levels of preoperative sexual bother, and higher education to be associated with absence of postoperative sexual bother, but another study could not identify any preoperative predictors of postoperative sexual bother. Severe sexual bother after radical prostatectomy was reported by 64% to 95% of patients 3 years after operation, and the prevalence was associated with the level of pretreatment sexual bother and peroperative nerve preservation. On the other hand, others have reported that only 43% of men have sexual bother 2 years after radical prostatectomy. However, none of these studies stratified patients according to their preoperative sexual activity and most of them were American. It has been shown that American findings concerning sexual bother may not always be valid for non-American patients due to differing sex role expectations, thus warranting the need for more non-American studies. This study has shown that two-thirds of patients experienced sexual bother 1 year after radical prostatectomy. We have identified patients with increased risk of experiencing overall sexual bother postoperatively: those who report preoperative sexual bother, those who are sexually active before radical prostatectomy, and those who display neurotic personality traits. Another important finding is that the proportion of patients who experienced bother relevant to having impaired postoperative sexual function was significantly higher among preoperatively sexually active patients than those who had been inactive. This study adds knowledge that patients' preoperative sexual activity, sexual bother and personality should be taken into account to be able to give individualized information about the risk of experiencing sexual bother after radical prostatectomy. Study Type--Therapy (outcomes research). Level of Evidence 2c. OBJECTIVE • To explore the prevalence and prediction of overall sexual bother (SB) 1 year after radical prostatectomy (RP) in relation to preoperative sexual activity and postoperative sexual function. PATIENTS AND METHODS • This prospective national study included 453 men who completed the sexual domain of the Expanded Prostate Cancer Index Composite before and 1 year after RP. • Preoperatively the patients were classified as sexually active or inactive based on frequency of intercourse during the previous 4 weeks. • The prevalence of 1-year SB and the proportion of bothered patients with impaired sexual function were calculated. • Preoperative factors significantly associated with postoperative SB on univariate analysis (P < 0.05) were included in multivariate regression analysis, post-prostatectomy SB being the dependent variable. RESULTS • The prevalence of SB increased from 18% preoperatively to 66% at 1 year after RP with a larger proportion of change in the active than the inactive group (59% vs 25%). • The proportion of men reporting postoperative SB related to their impaired sexual function 1 year after RP was significantly higher in the preoperatively sexually active group (83%) compared with the inactive group (63%). • In multivariate analysis preoperative SB, sexual activity and nervousness (neuroticism) significantly predicted postoperative SB with odds ratios of 3.71, 2.11 and 1.57, respectively. CONCLUSION • Sexual activity and SB the last month before prostatectomy and neuroticism identify men at risk of developing SB 1 year postoperatively. Assessment of preoperative sexual activity and SB should be a part of preoperative counselling.
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Affiliation(s)
- Eivind A S Steinsvik
- National Resource Center for Late Effects, Oslo University Hospital, Oslo, Norway.
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Clinical exercise interventions in prostate cancer patients--a systematic review of randomized controlled trials. Support Care Cancer 2011; 20:221-33. [PMID: 21989678 DOI: 10.1007/s00520-011-1271-0] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 09/06/2011] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Urinary incontinence, erectile dysfunction, fatigue as well as fears and depression rank among the most common complaints in patients with prostate cancer, resulting in a reduced participation in daily life and social isolation. Consequently, the quality of life of prostate cancer patients is strongly affected in a negative way. Numerous studies focusing on physical exercise interventions in prostate cancers patients demonstrate positive physiological and psychological effects. Our objective was to evaluate the evidence of randomized controlled studies which examined exercise during medical treatment and in the aftercare of a prostate cancer disease. METHODS Twenty-five randomized controlled trials regarding physical activities in patients with prostate cancer were obtained by systematic literature research (Medpilot). Twenty-one studies examined clinical exercise interventions during the phase of medical treatment (irradiation, pre- and/or post-op, androgen deprivation therapy) and four studies during the aftercare. In order to evaluate the evidence of the included studies, the evaluation system of the Oxford Centre for Evidence-Based Medicine was used. Within this systematic review, we differentiated between "supervised clinical exercise" and "non-supervised clinical exercise." RESULTS AND DISCUSSION Current data suggest that incontinence, fitness, fatigue, body constitution, and also quality of life can be improved by clinical exercise in patients during and after prostate cancer. Studies were mostly ranked evidence level "2b." Only four studies, all conducted during medical treatment, reached the level "1b." It seems to be that "supervised exercise" is more effective than "non-supervised exercise." For future research, further randomized controlled trials with high methodological quality need to be conducted in order to establish evidence-based recommendations particularly for prostate cancer patients.
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Abstract
Controlled tissue cooling, or hypothermia, has been used therapeutically for decades to mitigate the negative effects of traumatic, ischemic, and surgical insults. When applied systemically, moderate hypothermia can attenuate or prevent the extent of neurologic sequelae. Localized hypothermia, on the other hand, has the capacity to reduce tissue edema, suppress inflammation, and minimize the severity of peripheral nerve injury. Therapeutic hypothermia has been used in critical care, neurosurgery, ophthalmology, otolaryngology, cardiothoracic surgery and most recently in urology. Nerve injury during radical pelvic surgery can result in urinary incontinence or retention, impotence and bowel dysfunction. Localized hypothermia during radical prostatectomy has demonstrated improved recovery of urinary continence and erectile function, and similar benefits might be observed in other types of radical pelvic surgery.
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Affiliation(s)
- David S Finley
- Institute of Urologic Oncology, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Boulevard, Suite 1050, Los Angeles, CA 90095, USA.
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Vahlensieck W, Sommer F, Mathers MJ, Gilbert T, Waidelich R. [Counselling for erectile dysfunction during inpatient rehabilitation after radical prostatectomy]. Urologe A 2011; 50:417-24. [PMID: 21369872 DOI: 10.1007/s00120-010-2476-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
For men erectile function is essential for quality of life. Besides urine incontinence postsurgical erectile dysfunction (ED) following radical prostatectomy (RPE) represents a significant and prevalent problem. One of the first approaches to this condition should be a consultation performed by professionals in a rehabilitation clinic.A total of 149 patients post RPE participated in this prospective study. All patients were questioned about their understanding of postoperative surgical ED after RPE and if affected they were asked about their own psychological burden as well as their knowledge of possible therapy options. The qualities of presurgical patient information as well as the modules of information pertaining to ED during the rehabilitation were evaluated. Of the patients, 53% expressed that they experienced a considerable burden due to postsurgical ED during their follow-up rehabilitation (AR group) and 70% of the patients during oncological rehabilitation treatment (rehab group). Men who were sexually more active prior to surgery suffered more from postsurgical ED than their less active counterparts. A negative correlation between psychological burden and age was found in the AR group, which however was levelled in the rehab group. Particularly in older patients the burden of ED increases with more time elapsing after the operation. The medical information on ED therapy options provided during the inpatient rehabilitation was considered to be essential by 60% of the men in the AR group and 48% of the patients in the rehab group.Therapeutic possibilities for postsurgical ED following RPE cannot always be given to patients in the preoperative phase or during their stay in the hospital. Since however a large majority of men suffer from postoperative ED following RPE a specialized inpatient urological rehabilitation is suited for a comprehensive consultation.
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Affiliation(s)
- W Vahlensieck
- Abteilung für Urologie Onkologie Nephrologie, Rehabilitationsklinik Wildetal, Kliniken Hartenstein GmbH, Mühlenstraße 8, 34537 Bad Wildungen, Deutschland.
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Neuroanatomic basis for traction-free preservation of the neural hammock during athermal robotic radical prostatectomy. Curr Opin Urol 2011; 21:49-59. [DOI: 10.1097/mou.0b013e32834120e9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Oliffe JL, Gerbrandt JS, Bottorff JL, Hislop TG. Health Promotion and Illness Demotion at Prostate Cancer Support Groups. Health Promot Pract 2009; 11:562-71. [DOI: 10.1177/1524839908328990] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although health promotion programs can positively influence health practices, men typically react to symptoms, rather than maintain their health, and are more likely to deny than discuss illness-related issues. Prostate cancer support groups (PCSGs) provide an intriguing exception to these practices, in that men routinely discuss ordinarily private illness experiences and engage with self-health. This article draws on individual interview data from 52 men, and participant observations conducted at the meetings of 15 groups in British Columbia, Canada to provide insights to how groups simultaneously facilitate health promotion and illness demotion. The study findings reveal how an environment conducive to men’s talk was established to normalize prostate cancer and promote the individual and collective health of group members. From a gendered perspective, men both disrupted and embodied dominant ideals of masculinity in how they engaged with their health at PCSGs.
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Affiliation(s)
- John L. Oliffe
- School of Nursing, University of British Columbia, Vancouver, British Columbia,
| | | | - Joan L. Bottorff
- Faculty of Health and Social Development, University of British Columbia, Okanagan, Kelowna, British Columbia
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Ene KW, Nordberg G, Sjöström B, Bergh I. Prediction of postoperative pain after radical prostatectomy. BMC Nurs 2008; 7:14. [PMID: 19068111 PMCID: PMC2635357 DOI: 10.1186/1472-6955-7-14] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Accepted: 12/09/2008] [Indexed: 12/03/2022] Open
Abstract
Background There is a belief that the amount of pain perceived is merely directly proportional to the extent of injury. The intensity of postoperative pain is however influenced by multiple factors aside from the extent of trauma. The purpose of the study was to evaluate the relationship between preoperative factors that have been shown to predict postoperative pain and the self-reports of pain intensity in a population of 155 men undergoing radical prostatectomy (RP), and also to investigate if previous pain score could predict the subsequent pain score. Methods The correlation between potential pain predictors and the postoperative pain experiences during three postoperative days was tested (Pitmans' test). By use of a logistic regression analysis the probability that a Visual Analogue Scale (VAS) score at one occasion would exceed 30 mm or 70 mm was studied, depending on previous VAS score, age, depression and pain treatment method. Results Age was found to be a predictor of VAS > 30 mm, with younger patients at higher risk for pain, and preoperative depression predicted VAS > 70 mm. The probability that VAS would exceed 30 mm and 70 mm was predicted only by previous VAS value. Day two however, patients with epidural analgesia were at higher risk for experiencing pain than patients with intrathecal or systemic opioid analgesia. Conclusion The results show that it would be meaningful to identify RP patients at high risk for severe postoperative pain; i.e. younger and/or depressive patients who might benefit from a more aggressive therapy instituted in the very early postoperative period.
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Affiliation(s)
- Kerstin Wickström Ene
- The Sahlgrenska Acedemy at Göteborg University, Institute of Health and Care Sciences, Gothenburg, Sweden.
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Moore KN, Valiquette L, Chetner MP, Byrniak S, Herbison GP. Return to continence after radical retropubic prostatectomy: a randomized trial of verbal and written instructions versus therapist-directed pelvic floor muscle therapy. Urology 2008; 72:1280-6. [PMID: 18384853 DOI: 10.1016/j.urology.2007.12.034] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Revised: 11/24/2007] [Accepted: 12/05/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To test the effectiveness of weekly postoperative pelvic floor muscle training (PFMT) versus supportive telephone contact by a urology nurse for men at 4 weeks after radical prostatectomy. METHODS This was a randomized controlled trial in three Canadian centers. At 4 weeks after surgery, standardized verbal and written instruction about PFMT was provided to all subjects. Randomization occurred after initial instruction. Continence was defined as 8 g or less of urine loss on a 24-hour pad test. Primary outcome was grams of urine loss on pad test; secondary outcomes were International Prostate Symptom Score (IPSS), Incontinence Impact Questionnaire (IIQ-7) score, cost, and perception of urine loss as a problem. Data were obtained at baseline (preoperatively) and at weeks 4, 8, 12, 16, and 28 and 1 year after surgery. RESULTS A total of 216 men were enrolled; 11 were dry or withdrew at 4 weeks. Ninety-nine were randomized to the control group and 106 to the treatment group. There were no group differences at baseline for prostate-specific antigen level (mean [standard deviation] 8.4 [10.4] ng/mL; 7.6 [4.6] ng/mL), Gleason score (6.3 [0.86]), IPSS, IIQ-7 score, pad test, or voiding diary. At 8 weeks 23% of the control group and 20% of the treatment group were continent; at 12 weeks, 28% and 32%; 16 weeks, 40% and 44%; 28 weeks, 50% and 47%; and at 52 weeks, 64% and 60%, respectively. There were no significant differences between groups at any time point for the outcome variables. CONCLUSIONS Verbal instruction and written information with telephone support seemed to be as effective as intensive PFMT. Less-intense therapy may be more cost-effective.
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Affiliation(s)
- Katherine N Moore
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
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Liatsikos EN, Assimakopoulos K, Stolzenburg JU. Quality of Life after Radical Prostatectomy. Urol Int 2008; 80:226-30. [DOI: 10.1159/000127331] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Oliffe JL, Halpin M, Bottorff JL, Hislop TG, McKenzie M, Mroz L. How Prostate Cancer Support Groups Do and Do Not Survive: British Columbian Perspectives. Am J Mens Health 2007; 2:143-55. [DOI: 10.1177/1557988307304147] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Many prostate cancer support groups (PCSGs) have formed in North America during the past decade, yet their operation or factors influencing sustainability are poorly understood. This article reports micro (intragroup), meso (intergroup), and macro (group/structure) analyses drawn from the fieldwork and participant observations conducted for an ethnographic study of PCSGs based in British Columbia, Canada. The findings indicate that effective group leadership is integral to group sustainability and the recruitment and retention of attendees. At the meso level, intergroup connections and communication were often informal; however, the primary purpose of all the PCSGs was to provide information and support to men and their families. Many PCSGs were uncertain how formal associations with cancer fund-raising societies would influence group effectiveness. Macro issues such as prostate cancer activism resided with individual group “champions” through activities coordinated by provincial and national PCSG organizations. However, activism did not guarantee group sustainability. The study findings reveal why some groups flourish while others appear untenable, and form the basis for discussion about how PCSG sustainability might be best achieved.
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Affiliation(s)
- John L. Oliffe
- School of Nursing, University of British Columbia, Vancouver,
| | - Michael Halpin
- School of Nursing, University of British Columbia, Vancouver
| | - Joan L. Bottorff
- Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna
| | | | | | - Lawrence Mroz
- School of Nursing, University of British Columbia, Vancouver
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Abstract
The aim of this article is to selectively review the current research findings related to quality of life and prostate cancer. English-language journals indexed in MEDLINE, PubMed, and CINAHL published between 1999 and 2005 were searched for relevant articles using the following keywords: "quality of life and prostate cancer," "prostatectomy," "radiation therapy," "brachytherapy," "cryotherapy," or "androgen deprivation therapy." References in selected articles were reviewed for potentially relevant articles not identified through database searches. All treatment modalities have a significant impact on quality of life for men with local or advanced prostate cancer. Alterations in sexual functioning cause the most significant impact on quality of life for men. Quality of life is decreased in both the short and long term for men with prostate cancer. Oncology nurses must be cognizant of the challenges that a diagnosis of prostate cancer presents to the man with prostate cancer and his partner. Patients should be fully informed of the potential for impact on quality of life with all treatment modalities, and the oncology nurse can play an important role in both providing this information and supporting the patient when quality of life is impacted.
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Affiliation(s)
- Anne Katz
- CancerCare Manitoba, Winnipeg, Manitoba, Canada.
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