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

Abstract

ObjectivesTo measure the impact of psychotherapy associated to the use of Tadalafil in the improvement of erectile function after radical prostatectomy. MethodsFrom 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 20mg 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. ResultsThe 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). ConclusionsA 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.