Psicoterapia: una pieza que falta en el puzle de la rehabilitación de la disfunción eréctil tras prostatectomía radical / Psychotherapy: A Missing Piece in the Puzzle of Post Radical Prostatectomy Erectile Dysfunction Rehabilitation

Objetivos: Medir el impacto de la psicoterapia asociada al uso de tadalafilo en la mejoría de la función eréctil después de la prostatectomía radical. Métodos: De 132 pacientes intervenidos quirúrgicamente por cáncer de próstata 30 pacientes consecutivos con preservación nerviosa bilateral, enfermedad controlada de bajo riesgo y disfunción eréctil (DE) después de la cirugía tomaron tadalafilo 20 mg y se sometieron a sesiones de psicoterapia, ambas semanalmente durante 3 meses. Los pacientes fueron entrevistados para establecer la calidad de la erección utilizando el instrumento IIEF-5 y para medir las características psicológicas que afectan la función eréctil, los aspectos relacionados con la función, la disfunción, la incomodidad física y emocional se evaluaron con la ayuda de una escala de intensidad. Resultados: La media de edad era de 62,5 (46-77 años), el 96,7% tenía una relación estable, el 56,6% de los pacientes aceptó el diagnóstico y el 43,2% mostró mecanismos de defensa (3,3% negación, 6,6% repulsión y 33,3% preocupación). Se observó una correlación positiva entre la función eréctil y el tiempo de exposición al tratamiento (IIEF-5 -9,7 a 13,3; p = 0,0006), con un aumento de la satisfacción con la vida en general (2,1 a 2,7; p = 0,028) y de la vida sexual (3,1 a 3,7; p = 0,028), sumada a la facilitación de la expresión de sentimientos/emociones (1,8 a 3,0; p = 0,0008). La satisfacción con la relación y la intimidad con la pareja no presentó mejoría significativa (p = 0,12 y p = 0,61, respectivamente). Conclusiones: Una atención al paciente holísica con rehabilitación con DE más completa incluye psicoterapia con una correlación positiva entre la función eréctil y la exposición al tratamiento. La psicoterapia permitió la identificación de factores conyugales en este escenario

Objectives: To measure the impact of psychotherapy associated to the use of Tadalafil in the improvement of erectile function after radical prostatectomy. Methods: From 132 patients surgically treated for prostate cancer, 30 sequential patients with bilateral nerve sparing, low risk controlled disease and post-surgery erectile dysfunction (ED) took Tadalafil 20 mg and underwent psychotherapy sessions, both weekly for 3 months. Patients were interviewed to establish the quality of erection using the instrument IIEF-5 and to measure psychological features impacting erectile function, the aspects related to function, dysfunction, physical and emotional discomfort were evaluated with the help of an intensity scale. Results: The average age was 62.5 (46-77 years), 96.7% had a stable relationship, 56.6% of the patients accepted the diagnosis and 43.2% exhibited defense mechanisms (3.3% negation, 6.6% revulsion, 33.3% concern). A positive correlation was observed between erectile function and time exposed to treatment (IIEF-5 - 9.7-13.3, p = 0.0006), with increased satisfaction with life in general (2.1-2.7, p = 0.028) and sexual life (3.1-3.7, p = 0.028), added to facilitation of expressing feelings/emotions (1.8-3.0, p = 0.0008). Satisfaction with relationship and intimacy with partner did not present significant improvement (p = 0.12 and p = 0.61, respectively). Conclusions: A holistic patient care with more complete ED rehabilitation includes psychotherapy with a positive correlation between erectile function and treatment exposition. Psychotherapy allowed the identification of important spouse related factors in this scenario

Psychotherapy: a missing piece in the puzzle of post radical prostatectomy erectile dysfunction rehabilitation.

OBJECTIVES: To measure the impact of psychotherapy associated to the use of Tadalafil in the improvement of erectile function after radical prostatectomy. METHODS: From 132 patients surgically treated for prostate cancer, thirty sequential patients with bilateral nerve sparing, low risk controlled disease and post-surgery erectile dysfunction (ED) took Tadalafil 20mg and underwent psychotherapy sessions, both weekly for three months. Patients were interviewed to establish the quality of erection using the instrument IIEF-5 and to measure psychological features impacting erectile function, aspects related to function, dysfunction, physical and emotional discomfort were evaluated with the help of an intensity scale. RESULTS: The average age was 62.5 (46 to 77 years), 96.7% had a stable relationship, 56.6% of the patients accepted the diagnosis and 43.2% exhibited defense mechanisms (3.3% negation, 6.6% revulsion, 33.3% concern). A positive correlation was observed between erectile function and time exposed to treatment (IIEF-5 - 9.7 to 13.3, p=0.0006), with increased satisfaction with life in general (2.1 to 2.7, P=.028) and sexual life (3.1 to 3.7, P=.028), added to facilitation of expressing feelings/emotions (1.8 to 3.0, P=.0008). Satisfaction with relationship and intimacy with partner did not present significant improve (P=.12 and P=.61, respectively). CONCLUSIONS: A holistic patient care with more complete ED rehabilitation includes psychotherapy with a positive correlation between erectile function and treatment exposition. Psychotherapy allowed the identification of important spouse related factors in this scenario.