Sexual rehabilitation with intracavernous alprostadil after radical prostatectomy: Outcomes from a nursing program

Introduction and objectives: Erectile dysfunction (ED) is a common complication after radical prostatectomy that affects quality of life. There are several therapeutic options, including intracavernous alprostadil injections (IAI). However, no specific recommendations have been made on the optimal rehabilitation strategy. In this study we evaluated a sexual rehabilitation program (SRP) with IAI for patients with ED after radical prostatectomy, assessing the rate of compliance and reasons for dropout.Methods: The sexual rehabilitation program (SRP) was offered to all patients who underwent radical prostatectomy from 1 January 2010 to 31 December 2019. The first consultations were performed by a urology specialist nurse, explaining the IAI procedure and possible complications. The program was considered successful when the patients achieved autonomy in the drug preparation with a good injection technique. A medical consultation was performed at 6 months evaluating the IAI usage and adverse events. In case of dropout, a questionnaire about reasons for dropout was performed. The primary endpoint was the rate of compliance and dropout of the program. Secondary endpoints were the reasons for dropout and adverse events. Results: 340 patients underwent radical prostatectomy at our institution, and 123 patients accepted to participate in the rehabilitation program. A total of 96 patients (78%) successfully completed the SRP, and at 6 months 60 (62.5%) still used IAI. Concerning the reasons for dropping out, the most frequent were the need of injectable therapy and pain. Regarding complications, 17 patients (13.8%) reported pain related to the injection and 1 patient (0.8%) had a priapism, managed with conservative treatment. Conclusions: Management of post-radical prostatectomy ED by a nursing program achieved good rates of patients’ self-injection accomplishment and treatment compliance. Close monitoring for dose adjustment and management of post-injection penile pain is required during the follow-up.

Download Full-text

Sexual Rehabilitation and Penile Pain Associated with Intracavernous Alprostadil after Radical Prostatectomy

Journal of Sexual Medicine ◽

10.1111/j.1743-6109.2010.02002.x ◽

2011 ◽

Vol 8 (2) ◽

pp. 575-582 ◽

Cited By ~ 17

Author(s):

René Yiou ◽

Patrick Cunin ◽

Alexandre de la Taille ◽

Laurent Salomon ◽

Michele Binhas ◽

...

Keyword(s):

Radical Prostatectomy ◽

Sexual Rehabilitation ◽

Penile Pain

Download Full-text

OP270 Why The Haute Autorité de Santé Rejects the Widespread Use Of “Mini-Bypass”/One Anastomosis Gastric Bypass For Obesity In France

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462320000975 ◽

2020 ◽

Vol 36 (S1) ◽

pp. 4-4

Author(s):

Jean-Charles Lafarge ◽

Denis-Jean David ◽

Cédric Carbonneil

Keyword(s):

Esophageal Cancer ◽

Gastric Bypass ◽

Adverse Events ◽

Severe Obesity ◽

One Anastomosis Gastric Bypass ◽

Close Monitoring ◽

Efficacy And Safety ◽

Multicenter Rct ◽

Nutritional Complications

IntroductionOne anastomosis gastric bypass (OAGB) has become a widespread technique over the last few years in France, without any prior assessment and despite existing controversies among bariatric surgeons. An older bypass technique for treating obesity, the Roux-en-Y gastric bypass (RYGB), is available and reimbursed, having been assessed and approved for use in 2005. In 2019, the French Haute Autorité de Santé (HAS) assessed OAGB for the treatment of severe and massive obesity. This assessment, the first in the world, was undertaken for OAGBs carried out with a 200- or 150-centimeter biliopancreatic-limb (BP-limb) length.MethodsA systematic review (SR) of the literature and consultation of a working group consisting of both healthcare professionals (clinician and surgeons) and patients were carried out. The primary aim of our assessment was to determine whether the OAGB technique can replace RYGB. The efficacy and safety profile of OAGB was compared with RYGB in adult patients with massive, severe obesity. Complications and postoperative follow up specific to OAGB were identified.ResultsThe three selected randomized controlled trials (RCTs) could not confirm the superiority or the non-inferiority of OAGB, compared with RYGB, on the selected efficacy endpoints of weight loss, resolution of comorbidities, and quality of life. Adverse events reported for OAGB included severe nutritional complications and bile reflux that could potentially lead to lower esophageal cancer. In one RCT, the frequency of serious adverse events in the OAGB group was almost two times higher than in the RYGB group.ConclusionsHAS considered that OAGB carried out with a longer (200 centimeter) BP-limb is not a validated technique for the surgical treatment of massive, severe obesity. Thus, it cannot be considered an alternative to RYGB. There were insufficient data available on OAGB performed with a 150-centimeter BP-limb. Thus, HAS recommended undertaking a multicenter RCT to assess the efficacy and safety of OAGB. Patients who have already undergone OAGB should receive the same follow up as patients who have received RYGB, including close monitoring for nutritional complications and lower esophageal cancer and an endoscopic examination five years after surgery.

Download Full-text

Focusing on sexual rehabilitation besides penile rehabilitation following radical prostatectomy is important

International Journal of Impotence Research ◽

10.1038/s41443-021-00420-z ◽

2021 ◽

Cited By ~ 1

Author(s):

Daphné Vanderhaeghe ◽

Maarten Albersen ◽

Emmanuel Weyne

Keyword(s):

Radical Prostatectomy ◽

Sexual Rehabilitation ◽

Penile Rehabilitation

Download Full-text

Phenotyping of CYP 4501A2 Activity by Total Overnight Salivary Caffeine Assessment (TOSCA) in Patients on Warfarin Treatment: A Cross-Sectional Study

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029617733040 ◽

2017 ◽

Vol 24 (6) ◽

pp. 928-935 ◽

Cited By ~ 1

Author(s):

Giovanni Tarantino ◽

Domenico Capone ◽

Paola Contaldi ◽

Adriana Gianno ◽

Mosca Teresa ◽

...

Keyword(s):

Adverse Events ◽

Drug Concentration ◽

Ethical Issues ◽

Single Point ◽

Warfarin Dose ◽

Individual Variability ◽

Bleeding Complications ◽

Close Monitoring ◽

Cross Sectional ◽

Warfarin Sodium

Warfarin is an oral anticoagulant, commonly used for primary and secondary prevention of venous and arterial thromboembolic events. The drug is characterized by narrow therapeutic index, widespread individual variability in clinical response, and high rates of adverse events, particularly bleeding complications. For these reasons, a close monitoring of the dosage, using the frequent assessment of coagulation status by means of International Normalized Ratio value, is mandatory. Warfarin is metabolized by hepatic cytochrome P-450. High CYP 450 activity may lead to low drug concentration and requires high warfarin doses to reach efficacy; conversely, low CYP 450 activity is responsible for high drug concentration and needs for low doses to avoid potential toxicity risks. The major isoforms of CYP involved in the metabolism of warfarin sodium are CYP1A2 (for the R-warfarin) and CYP2C9 (for the S-warfarin). The probes for testing CYP1A2 are phenacetin and caffeine while for CYP2C9 tolbutamide. Although S-warfarin has major activity, it was decided to exclude its phenotyping for ethical issues, being mandatory to use a drug (tolbutamide). Instead, it was chosen to test the 1A2 isoform, as the activity of the latter isoform could be investigated by using caffeine contained in the caffeinated beverages. Specifically, a single-point concentration of salivary caffeine (total overnight salivary caffeine assessment [TOSCA]) after an overnight period of the caffeinated beverages abstinence was utilized. In the present study, 75 nonsmoker patients regularly receiving warfarin sodium were enrolled. The results have showed a significant association of the warfarin dose with TOSCA values (coefficient = –0.15, standard error = 0.04, 95% confidence interval = –0.24 to –0.06, t = –3.23, P = .002). In conclusion, the phenotyping of CYP1A2 by TOSCA could be useful, if further proven, to help manage patients on warfarin in order to lessen severe adverse events.

Download Full-text

Patient Education for Radical Prostatectomy: Development of a Program Tailored to the Needs of Prostate Cancer Patients

American Journal of Men s Health ◽

10.1177/15579883211063317 ◽

2021 ◽

Vol 15 (6) ◽

pp. 155798832110633

Author(s):

Jean-Etienne Terrier ◽

Alain Ruffion ◽

Chloé Hamant ◽

Vanessa Rousset ◽

Julie Kalecinski ◽

...

Keyword(s):

Prostate Cancer ◽

Patient Education ◽

Radical Prostatectomy ◽

Cancer Patients ◽

Health Belief ◽

Rehabilitation Program ◽

Patient Education Program ◽

Belief Model ◽

The Health Belief Model ◽

Tailored Program

In all, 30% to 90% of prostate cancer patients undergoing radical prostatectomy (RP) recover their erectile capacity. No effective post RP erectile rehabilitation program exists to date. The aim of this exploratory qualitative study is to explore the needs of these patients and to develop a patient education program (PEP) which meets these needs. Interviews were carried out by a socio-anthropologist with prostate cancer patients treated by RP within the 6 previous months. The needs and expectations identified led to the choice of a logical model of change for the construction of the PEP. Nineteen patients were included in the study; 17 of them were living with a partner. Two categories of patients appeared during the interviews: informed patients resigned to lose their sexuality and patients misinformed about the consequences of the surgery. The tailored program was built on the Health Belief Model and provides six individual sessions, including one with the partner, to meet the needs identified. This study designed the first program to target comprehensively the overall sexuality of the patient and his partner, and not only erection issues. To demonstrate the effectiveness of this program, a controlled, multicentric clinical trial is currently ongoing.

Download Full-text

Ruxolutinib in Steroid Refractory Graft Versus Host Disease (SR-GVHD): Systemic Literature Review

Blood ◽

10.1182/blood-2019-129538 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 5682-5682

Author(s):

Mostafa F. Mohammed Saleh ◽

Shahrukh K. Hashmi

Keyword(s):

Adverse Events ◽

Graft Versus Host Disease ◽

Chronic Gvhd ◽

Infectious Complications ◽

Systemic Review ◽

Close Monitoring ◽

Hematopoietic Stem ◽

Host Disease ◽

Graft Versus Host ◽

Steroid Refractory

Background: Graft versus host disease (GVHD) is a main cause of morbidity and mortality in patients having undergone allogeneic hematopoietic stem cell transplantation (HSCT). About 30-40% of patients have steroid‐refractory GVHD (SR‐GVHD) after the first‐line use of high doses of corticosteroids with a poor prognosis .Ruxolitinib is a promising treatment for SR-GVHD. However, data regarding optimum dosing, response rates and associated adverse events are scarce. Herein, we provide the first systemic review of literature for the use ruxolutinib in GVHD. Methods: A Medline (PubMed), google scholar, OVID and Cochrane Database of Systematic Reviews search using key words "Ruxolutinib and GVHD", "Ruxolutinib and SR-GVHD" was undertaken in June 2019. Only peer reviewed databases were searched and search was restricted to human studies of acute and chronic GVHD only. Results: 16 publications, as listed in Table 1. Only one was a prospective trial, all others were retrospective studies, case series (5), and case reports (2). Overall response, ranged 45% - 100%, complete response was noted in 5.2% -80% patients. Time to response was variable from 1-12 weeks. Cytopenias and infectious complications were frequently reported with dose reduction or interruptions needed in most studies. Maintained responses were reported in a small proportion after ruxolutinib discontinuation. Conclusion Ruxolutinib has promising efficacy in SR-GVHD , however cytopenias and infectious complications reported frequently mandate close monitoring. Results of ongoing prospective trials could provide answers for optimum dosing and response assessment, and management of related adverse events. Table Disclosures No relevant conflicts of interest to declare.

Download Full-text