POSSIBILITIES OF COMBINATION TREATMENT FOR PRESERVING THE SEXUAL FUNCTION IN PATIENTS AFTER RADICAL PROSTATECTOMY FOR LOCALIZED PROSTATE CANCER (3)
FINDINGS AND DISCUSSIONS
When evaluating penis rigidity according to PHS, the following results were obtained: in the first group, the degree of erectile rigidity was 3.1 before the surgery, by the 7th day after surgery, it reduced by 1.22±0.2. By the 30th and 90th days the result was 2, which corresponds to a sufficiently hard penis, but not hard enough for penetration and sexual intercourse.
The data obtained in the second and third groups did not differ and were characterized by a decrease in penis hardness during the first 7 days, and then by an increasing tendency up to the 3rd degree, which is characterized by a hardness sufficient for penetration.
In the first group, the quality of life according to the QOL scale was 2.1 points before the surgery; 7 days after the surgery it reduced by 2.05±0.3 points, after which a positive increasing tendency was observed; thus, the average life quality level measured 3.7 points on the 30th and 90th days after the surgery.
In the second and third groups, the lowering of the quality of life to 4.15 points was also registered by the 7th day, and by the 30th and 90th day, the quality of life increased to 2.4 points in the second group and to 2.6 points in the third group. No statistically significant differences in the life quality level were observed between the second and third groups.
According to the literature data, no convincing data is currently available on the application of PDE-5 inhibitors for the rehabilitation of sexual function in males after radical prostatectomy for localized prostate cancer. Also, there is no unanimous opinion concerning doses, terms and time of taking PDE-5 inhibitors by this category of patients.
According to the findings by A. Briganti and co-authors , in the group where patients constantly took PDE-5 inhibitors, erectile dysfunction was observed much less frequently (37%) compared to the control group (73%, p<0.001), which is generally comparable to the data obtained in the course of the research study. After 3 months, the erectile dysfunction incidence was 75% (15 patients) in the control group, less by 15% (which corresponds to 60%) in the second group (12 patients) and less by 20% in the third group, namely 55% (11 patients).
Some research studies showed evidence of penis shortening by1-3 cm in patients after radical prostatectomy during a one-year observation period. [19, 20] This research study considered changes in penis length during a period of three months after surgical treatment, which demonstrated the length reduction by up to 1.64±0.12 cm in the control group, the penis shortening degree in the second group was lower: 1.175±0.01 cm on the average.
Possible mechanisms responsible for penile length shortening may be cavernosal fibrosis, caused by apoptosis of the smooth muscle cells of cavernous bodies after injury to the pelvic splanchnic nerves (nervi erigentes).
Earlier studies  showed that using vacuum extenders allows the penis length to be preserved after radical prostatectomy. At the same time, opinions differ as to using vacuum extenders considering the cavernosal fibrosis hazard resulting from cavernous body ischemia, acidosis and insufficient relaxation of smooth muscles . Our findings show that combining daily intake of PDE-5 inhibitors with daily use of a vacuum extender makes it possible not only to preserve the penis length, but also to increase the penis length by 0.75±0.01 cm.
In modern society, quality of life is an essential part of a patient’s general health and wellness. Numerous research studies dedicated to life quality assessment proved the importance and necessity of developing and introducing patient rehabilitation programs. At present, no distinct and recommended rehabilitation algorithms with proven efficiency are available for patients after radical prostatectomy [7, 14, 15, 16, 17].