Андрология и генитальная хирургия. 2017; 18: 80-86
ЛЕЧЕНИЕ ЭРЕКТИЛЬНОЙ ДИСФУНКЦИИ У ПАЦИЕНТОВ С РАКОМ ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫ ПОСЛЕ РАДИКАЛЬНОЙ ПРОСТАТЭКТОМИИ
https://doi.org/10.17650/2070-9781-2017-18-1-80-86Аннотация
Проблема лечения рака предстательной железы (РПЖ) в настоящее время стоит очень остро в России и во всем мире. По данным, полученным в Санкт-Петербурге, рост заболеваемости РПЖ за период с 1990 по2002 г. составляет 141,3 %. Даже в случае выполнения нервосберегающей радикальной простатэктомии (РПЭ) эректильная дисфункция той или иной выраженности наблюдается у 65–75 % пациентов. На этапе дообследования собирался анамнез сексуальной жизни, включающий информацию о предыдущих и настоящих сексуальных контактах. Использовали анкетирование с помощью Международного индекса эректильной функции, который помогает оценить различные параметры сексуальной функции (половое влечение, эрекция, оргазм, эякуляция, половой акт и удовлетворение сексуальными отношениями), а также определить эффективность применяемых методов лечения. Нами проводилось комбинированное двухэтапное лечение эректильной дисфункции при РПЖ после РПЭ. На первом этапе применяли ингибиторы фосфодиэстеразы 5-го типа (силденафил 100 мг). При неэффективности препаратов на этом этапе лечения переходили ко 2-му этапу (внутрикавернозные инъекции алпростадила). Оценивали эффективность препаратов, осложнения, комплаентность пациентов.
Список литературы
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Andrology and Genital Surgery. 2017; 18: 80-86
TREATMENT OF ERECTILE DYSFUNCTION IN PATIENTS WITH PROSTATE TUMOR AFTER RADICAL PROSTATECTOMY
https://doi.org/10.17650/2070-9781-2017-18-1-80-86Abstract
Prostate cancer (PC) treatment is a pressing problem both inRussiaand worldwide. According to data for Saint-Petersburg, from 1990 to 2002 morbidity increase rate for PC was 141.3 %. Even after nerve-sparing radical prostatectomy (RP) erectile dysfunction of some level is observed in 65–75 % of patients. During follow-up examination, data on sexual history were gathered including information on past and current sexual contacts. A questionnaire based on the International Index of Erectile Function was used which allows to evaluate different parameters of sexual function (sexual drive, erection, orgasm, ejaculation, sexual act, and satisfaction with sexual relationships), as well as determine treatment effectiveness. We performed combined two-stage treatment of erectile dysfunction in patients with PC after RP. At the first stage, phosphodiesterase type 5 inhibitors (sildenafil 100 mg) were used. If the drug was ineffective, the second stage was initiated (intracavernosal alprostadil injections). Drug effectiveness, complications, patient compliancy were evaluated.
References
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2. Lue T.F., Tanagho E.A. Physiology of erection and pharmacological management of impotence. J Urol 1987;137(5):829–36.
3. Salonia A., Burnet A.L., Graefen M. et al. Prevention and management of post prostatectomy sexual dysfunctions. Part 1: choosing the right patient at the right time for the right surgery. Eur Urol 2012;62(2):261–72.
4. Robinson J.W., Moritz S., Fung T. Metaanalysis of rates of erectile function after treatment of localized prostate carcinoma. Int J Radiat Oncol Biol Phys 2002;54(4):1063–8.
5. Moreland R.B. Is there a role of hypoxemia in penile fibrosis: a viewpoint presented to the society for the study of impotence. Int J Impot Res 1998;10:113–20.
6. Hatzimouratidis K., Burnett A.L., Hatzichristou D. et al. Phosphodiesterase type 5 inhibitors in postprostatectomy erectile dysfunction: a critical analysis of the basic science rationale and clinical application. Eur Urol 2009;55: 334–47.
7. Canada A.L., Neese L.E., Sui D., Schover L.R. Pilot intervention to enhance sexual rehabilitation for couples after treatment for localized prostate carcinoma. Cancer 2005;104(12):2689–700.
8. Kendirci M., Hellstorm W.J. G. Contemp Urol 2005;17:36–50.
9. User H.M., Hairston J.H., Zelner D.J. et al. Penile weight and cell subtype specific changes in a post-radical prostatectomy model of erectile dysfunction. J Urol 2003;169:1175–9.
10. Leungwattanaki S., Bivalacgua T., Usia M. Cavernous neurotomy causes hypoxia and fibrosis in rat corpus cavernosum. J Androl 2003;24:239–45.
11. Savoie M., Kim S., Solovay M. A prospective study measuring penile length in men treated with radical prostatectomy for prostate cancer. J Urol 2003;169:1462–64.
12. Munding M.D., Wessell H.B.,, Dalkin B.L. Pilot study of changes in stretched penile length 3 months after radical retropubic prostatectomy. Urology 2001;58(4):567–9.
13. Savoie M., Kim S.S., Soloway M.S. A prospective study measuring penile length in men treated with radical prostatectomy for prostate cancer. J Urol 2003;169(4):1462–4.
14. Gontero P., Galcerano M., Bartoletti R. New insights into the pathogenesis of penile shortening after radical prostatectomy and the role of postoperative sexual function. J Urol 2007;178:602–7.
15. Mulhall J., Slovick R., Hotaling J. et al. Erectile dysfunction after radical prostatectomy: hemodynamic profiles and their correlation with the recovery of erectile function. J Urol 2002;167:1371–5.
16. Montorsi F., Guazzoni G., Strambi L. et al. Recovery of spontaneous erectile function after nerve-sparing radical retropubic prostatectomy with and without early intracavernous injections of alprostadil: results of a prospective, randomized trial. J Urol 1997;158: 1408–10.
17. Walsh P.C. Patient-reported urinary continence and sexual function after anatomic radical prostatectomy. J Urol 2000;164 (1):242.
18. Burnett A.L. Rationale for cavernous nerve restorative therapy to preserve erectile function after radical prostatectomy. Urology 2003; 61:491–7.
19. Briganti A., Gallina A., Suardi N. et al. Predicting erectile function recovery after bilateral nerve sparing radical prostatectomy: a proposal of a novel preoperative risk stratification. J Sex Med 2010;7:2521–31.
20. Rosen R.C., Riley A., Wagner G. et al. The international index of erectile function (IIEF): a multidimensional scal for assessment of erectile dysfunction. Urology 1997;49(6):822–30.
21. Teloken P., Mesquita G., Montorsi F., Mulhall J. Post-radical prostatectomy pharmacological penile rehabilitation: practice patterns among the international society for sexual medicine practitioners J Sex Med 2009;6(7):2032–8.
22. Schwartz E.J., Wong P., Graydon R.J. Sildenafil preserves intracorporeal smooth muscle after radical retropubis prostatectomy. J Urol 2004;171(2 Pt 4):771–4.
23. McCullough A. R., Barada J.H., Fawzy A. et al. Achieving treatment optimization with sildenafil citrate (Viagra) in patients with erectile dysfunction. Urology 2002;60(2 Suppl 2):28–38.
24. Padma-Nathan H., McCullough A. R., Levine L.A. et al. Study Group. Rundomized, double-blind, placebocontrolled study of postoperative nightly sildenafil citrate for the prevention of erectile dysfunction after bilateral nerve-sparing radical prostatectomy. Int J Impot Res 2008;20(5):479–86.
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