Management of Post-RALP SUI and ED - What are and What Should we be Doing?

IF 2.5 2区医学 Q2 UROLOGY & NEPHROLOGY Current Urology Reports Pub Date : 2024-11-15 DOI:10.1007/s11934-024-01249-x

Thairo A Pereira, Jacob O Rust, Helen L Bernie

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Abstract

Purpose of review: Although there have been advancements in minimally invasive surgical techniques for radical prostatectomy, surgery can still significantly impact continence and erectile function (EF), resulting in considerable quality-of-life impairment. This review critically evaluates existing treatment options for male stress urinary incontinence (SUI) and erectile dysfunction (ED) post-robotic-assisted laparoscopic prostatectomy (RALP), alongside exploring emerging trends and discussing future directions for managing and preventing both conditions.

Recent findings: Patient history is pivotal in guiding surgical decisions, with the intensity of symptoms and their impact on the patient's life being primary influences for deciding the best treatment options for both SUI and ED. Penile rehabilitation strategies (PR) show promise in mitigating the effects of prostate cancer treatments on EF and improving overall health, though consensus is lacking on specific programs or initiation of timing for optimal recovery post-surgery. All patients undergoing RALP should receive preoperative counseling about SUI and early pelvic floor physical therapy. Fixed and adjustable slings effectively treat mild-to-moderate post-RALP SUI, while the artificial urinary sphincter is the gold standard for men with moderate or severe SUI. EF recovery after RALP faces obstacles such as patient characteristics, compliance, and cost, with no standardized PR approach. Future research should prioritize studies aiming to optimize treatment methods and enhance patient compliance.

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RALP 术后 SUI 和 ED 的管理--我们正在做什么和应该做什么？

综述目的：尽管根治性前列腺切除术的微创手术技术不断进步，但手术仍会严重影响尿失禁和勃起功能（EF），导致生活质量严重下降。这篇综述对机器人辅助腹腔镜前列腺切除术（RALP）术后男性压力性尿失禁（SUI）和勃起功能障碍（ED）的现有治疗方案进行了严格评估，同时探讨了新的趋势，并讨论了管理和预防这两种疾病的未来方向：患者病史在指导手术决策方面至关重要，症状的强度及其对患者生活的影响是决定 SUI 和 ED 最佳治疗方案的主要影响因素。阴茎康复策略（PR）在减轻前列腺癌治疗对EF的影响和改善整体健康方面大有可为，但对于手术后最佳康复的具体方案或启动时机还缺乏共识。所有接受前列腺癌根治术（RALP）的患者都应该在术前接受有关 SUI 的咨询，并尽早接受盆底物理治疗。固定式和可调式吊带可有效治疗 RALP 术后轻度至中度 SUI，而人工尿道括约肌是治疗中度或重度 SUI 男性的金标准。RALP 术后 EF 恢复面临着患者特征、依从性和成本等障碍，没有标准化的 PR 方法。未来的研究应优先考虑旨在优化治疗方法和提高患者依从性的研究。

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来源期刊

Current Urology Reports UROLOGY & NEPHROLOGY-

CiteScore

4.60

自引率

3.80%

发文量

期刊介绍： This journal intends to review the most important, recently published findings in the field of urology. By providing clear, insightful, balanced contributions by international experts, the journal elucidates current and emerging approaches to the care and prevention of urologic diseases and conditions. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as benign prostatic hyperplasia, erectile dysfunction, female urology, and kidney disease. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.