Optimization of functional results of radical prostatectomy. Rehabilitation programs for patients

Aboyan I.A., Orlov Yu.N., Pakus S.M., Pakus D.I., Aboyan V.E.

Introduction. Currently,radical prostatectomy (RPE) is considered as the main method of the surgical treatment of localized forms of prostate cancer(PCa),which provides a high relapse-free survival. Urinary incontinence and erectile dysfunction (ED) are the common complications of this surgery. Unfortunately, nowadays there is no unified approach to the rehabilitation of patients after RPE.

Materials and methods. In orderto resolve thisissue,we created a postoperative program. The integrated into the intrahospital information system softwarewas developed to implement the rehabilitation program, and the PCa patient registry was provided. Validated questionnaires ICIQ-SF, IIEF-5 and pad-test were used to evaluate functional results. Three lines of instrumental/apparatus and pharmacological treatment are used in the rehabilitation of patients with ED and urinary incontinence, taking into account the duration of the postoperative period, the results of urodynamic studies and the individual characteristics of the patient.

Results. 84 patientsreceived complex treatment aer RPE in the “Rehabilitation Center”. The average score of the patientswith urinary incontinence on the ICIQ-SF was 14 points before the beginning of rehabilitation (severe urine incontinence), meanwhile, after the end of the 3rd rehabilitation line, 37 patients(86%) already had 5 points(mild urine incontinence) (p <0.01). Surgical treatment (4th line therapy) was performed on 3 patients (7%) with urinary incontinence. The average score of the patients with ED on IIEF-5 was 8 points (large degree of ED) after RPE before the beginning of rehabilitation. After the end of the 2nd line of rehabilitation, 11 patients (45.8%) 16 points (mild ED) (p <0.01). 4 patients (16.8%) who had an average score of 12 on the IIEF-5, refuse 3rd and 4th rehabilitation lines and continued non-invasive treatment.

In case of 7 patients(29%), who had serve erectile dysfunction after 2 lines of rehabilitation, intracavernous injections of alprostadil were administrated asthe main method ED treatment(3rd line ofrehabilitation). Surgical treatment(4th line ofrehabilitation)was performed on 2 patients (8.4%).

Comclusion. The rehabilitation program for patients after radicalsurgical treatment of localized PCa, which allows to speed up the recovery of urinary continence and erectile function and reduce the frequency of surgical correction of these complications,was created and implemented by MBI of public health, CDC “Health”, Rostov-Don.

Authors declare lack of the possible conflicts of interests

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prostate cancer, surgical treatment, urinary incontinence, erectile dysfunction, rehabilitation program, automated system

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