Is it Worth Starting Sexual Rehabilitation Before Radical Prostatectomy? Results From a Systematic Review of the Literature

Nadja Schoentgen; Gianluigi Califano; Celeste Manfredi; Javier Romero-Otero; Felix K H Chun; Idir Ouzaid; Jean-François Hermieu; Evanguelos Xylinas; Paolo Verze

doi:10.3389/fsurg.2021.648345

Is it Worth Starting Sexual Rehabilitation Before Radical Prostatectomy? Results From a Systematic Review of the Literature

Front Surg. 2021 Apr 21:8:648345. doi: 10.3389/fsurg.2021.648345. eCollection 2021.

Authors

Nadja Schoentgen¹, Gianluigi Califano^{1

2}, Celeste Manfredi^{2

3}, Javier Romero-Otero³, Felix K H Chun⁴, Idir Ouzaid^{1

5}, Jean-François Hermieu^{1

5}, Evanguelos Xylinas^{1

5}, Paolo Verze⁶

Affiliations

¹ Department of Urology, Bichat Claude Bernard Hospital, Paris, France.
² Department of Neurosciences, Reproductive Sciences, Odontostomatology, University of Naples Federico II, Naples, Italy.
³ Department of Urology, Instituto de Investigation Sanitaria Hospital 12 de October (imas12), Hospital Universitario 12 October, Madrid, Spain.
⁴ Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany.
⁵ University of Paris, Paris, France.
⁶ Department of Medicine, Surgery, Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy.

Abstract

Background and Purpose: Sexual dysfunction (SD) is a frequent side effect associated with radical prostatectomy (RP) for prostate cancer (PCa). Some studies have showed the benefit associated with preoperative sexual rehabilitation (prehabilitation) and Enhanced Recovery After Surgery (ERAS) for RP, but no clear clinical recommendations are available yet. Our aim was to conduct a systematic review on sexual prehabilitation prior to RP for patients with a localized PCa and analyze the impact on postoperative sexual health compared with the standard post-operative care. Methods: We performed a systematic review of the literature following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) recommendations. Results: Four randomized control trials and one retrospective comparative study were included in the analyses. Three of the five studies showed an improved EF recovery post-RP in the prehabilitation group compared to the standard of care represented by: higher International Index of Erectile Function 5 score (IIEF5) or IIEF score (p < 0.0001) and a higher percentage of patients reporting return of EF based on the Sexual Encounter Profile (SEP) (56 vs. 24%, p = 0.007). Self-confidence, therapeutic alliance, and adherence to treatment were stronger for patients with preoperative consultations (p < 0.05) and EF recovery was better in cases of a higher number of follow-up visits (OR 4-5 visits vs. 1:12.19, p = 0.002). Discussion: Despite heterogenous methods and high risks of bias in this systematic review, starting sexual rehabilitation prior to surgery seems to ensure better EF recovery. This prehabilitation should include information of both the patient and his or her partner, with a closer follow up and the use of a multimodal treatment approach that still remains to be defined and validated (oral medication, vacuum devices, pelvic floor muscle training, etc.).

Keywords: prehabilitation; prostate cancer; radical prostatecomy; sexual dysfunction; sexual rehabilitation.

Publication types

Systematic Review