Some patients require the early administration of erectile drugs after prostate surgery to regain full sexual function.
Researchers have noted that patients often drop out of therapy programs, which include taking these medications. A recent study found that a partner’s lack of support may be behind the decision to stop therapy.
"Sexual function after prostate surgery is possible - ask a doctor."
Massimo Polito, MD, Department of Clinical and Specialistic Sciences, Polytechnic University of the Marches Region Medical School, Ancona, Italy, and his fellow scientists reviewed information about 430 men who underwent radical prostatectomy. Their average age was 65, and all reported being sexually active prior to surgery.
For prostate cancer patients, surgery is a common treatment if the cancer has not spread outside of the gland. In a radical prostatectomy, a surgeon removes the whole prostate gland and tissue around it, including seminal vessels.
The nerves that allow men to get erections may be damaged or removed during surgery.
In this study, all patients were offered an ED rehabilitation program, which includes the administration of alprostadil (trade name Caverject). Alprostadil works by relaxing the muscles and blood vessels in the penis to keep enough blood there so an erection can occur.
Participants were seen once a week and taught how to self-inject the medication. Administration begins with a starting dose of 2 to 3 micrograms. Thereafter, dosage is adjusted according to how the patient has reacted to the drug.
This ED rehabilitation program was accepted by 273 patients and rejected by 157. Investigators attributed this refusal to participate to patient’s lack of sexual interest in 81 cases (51.6%) and lack of interest from the spouse/partner in 46 cases (30.2%).
“The present data highlight the role of spouses/partners, whose lack of interest in sexual intercourse was the underlying reason for about 30 percent of negative decisions,” said the study authors.
“This surprising factor must be a focus of the postoperative management of what is, in effect, no longer a single patient, but a more complex entity—the couple.”
Researchers commented that a change of focus—from the patient to the couple—may be needed when it comes to counseling.
Of the patients who did go ahead with the alprostadil treatment, about 19 percent dropped out over the first six months. The primary reason for discontinuing drug therapy was ineffectiveness or disappointment with results, despite attempts at adjusting dose.
The second most common reason for stopping was pain from self-injection.
“It is our opinion that early administration of injected drugs and careful counseling and support are required to motivate patients to pursue this goal [recovery of sexual potency],” said Dr. Politi and co-authors.
The study was published online in October in the British Journal of Urology International. No conflicts of interest were declared.