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Radical prostatectomy patients have unrealistic expectations with regard to their long-term sexual function: men underestimate sexual dysfunction risks (2016-01-10)

Men with prostate cancer have several treatment options, which include active surveillance, radiation and removing the gland altogether. All have potential side effects.

The Prostate - Henry Gray - Anatomy of the Human Body

Sexual dysfunction remains common after treatment, including erectile dysfunction (ED), changes in orgasm and penile morphology. The incidence of these problems varies depending upon the definition used as well as the timing and method of patient assessment after definitive treatment.

Previous studies have shown that the perceptions of urologists and the expectations of the patients do not necessarily concur.
Clinical experience suggests that some radical prostatectomy (RP) patients have unrealistic expectations with regard to their long-term sexual function.

A new study was undertaken in an effort to assess the understanding of patients who underwent radical prostatectomy with regard to their postoperative sexual function.

Patients presenting within 3 months of their radical prostatectomy (open and robotic) were questioned regarding the sexual function information that they had received pre-operatively.
Patients were questioned about erectile function, postoperative ejaculatory status, orgasm and postoperative penile morphology changes. Statistical analyses were performed to assess for differences between patients who underwent open versus robotic radical prostatectomy.

As reported in BJU International, Mulhall and colleagues surveyed 336 consecutive patients (from 9 surgeons) with a mean age of 64±11 years had the survey instrument administered (216 underwent open and 120 underwent robotic radical prostatectomy).

No significant differences existed in patient age or comorbidity profiles between the two groups.
Only 38% of men had an accurate recollection of their nerve sparing status.
The mean (SD) elapsed time post-RP at the time of postoperative assessment was 3 months.

Robotic radical prostatectomy patients expected shorter EF recovery time (6 vs 12 months, p=0.02), a higher likelihood of recovery back to baseline erectile function (75 vs. 50%, p=0.01), and lower potential need for ICI (4 vs. 20%, p=0.01).

None of the robotic RP patients and only 10% of open RP patients recalled being informed of the potential for penile length loss (p<0.01) and none were aware of the association between RP and Peyronie’s disease.

Almost half of all patients were unaware that they were rendered anejaculatory by their surgery.

Patients who have undergone radical prostatectomy have largely unrealistic expectations with regard to their postoperative sexual function. Disclosure does not equate to understanding.

For more information
A survey of patient expectations regarding sexual function following radical prostatectomy