A variety of penile rehabilitation (PR) therapies are available to improve post-prostatectomy erectile dysfunction (ED) with mixed results. It is uncertain how adherent men are to PR therapies. The aim of this study is to determine adherence to and identify barriers to PR treatment. A longitudinal cross-sectional approach was used in men who underwent radical prostatectomy over 2 years. Men were instructed to take a PDE5 inhibitor (PDE5i) three times per week, and if required, utilize a vacuum constriction device (VCD) daily. Outcomes were measured by multiple validated questionnaires. In addition, penile stretched length, side effects, compliance to PR regimen & barriers to participation were documented. Seventy-seven patients were enrolled, however only 49 completed evaluation at 3 or more timepoints and were included in analysis. This cohort was an average age of 58.1 years (±7.7), had robotic laparoscopic radical prostatectomy (91.7%), and had bilateral nerve sparing procedures (95.8%). Majority (62.5%) reported normal SHIM pre-operatively, however 79% used PDE5i. Erectile function as measured by IIEF and Erection Hardness Rating were negatively affected post-operatively, with gradual improvement in parameters throughout the 24 month follow up. Of the participants who had normal pre-op SHIM, only 23.1 and 28.6% regained baseline function at 1 and 2 years, respectively. Orgasm was significantly diminished immediately post-operatively, however, at the end of the study period only 37% of men reported diminished climax and no men reported absent orgasm. Adherence to penile rehabilitation therapies declined overtime. Men took oral PDE5i on average 2.3 times weekly at 12 and 24 months (p < 0.001). Men used the VCD 2.3–3.9 days a week, which declined overtime (p = 0.014). Improvement in erectile and orgasm parameters was observed over time, but most men did not return to baseline function. Despite comprehensive instructions and a frequent follow up schedule, PDE5i and VCD adherence was poor. High attrition rates were noted with only 55.8% of men remaining at 12 months and 45% of men completing 24 months. The most common barriers to PR adherence were cost, inconvenience and perceived ineffectiveness.

中文翻译：

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前列腺癌根治术后2年内阴茎康复的依从性和障碍

可以使用多种阴茎康复（PR）治疗来改善前列腺切除术后的勃起功能障碍（ED），但效果不一。不确定男性对PR治疗的依从性如何。这项研究的目的是确定对PR治疗的依从性并确定其障碍。进行了2年以上前列腺癌根治术的男性使用了纵向横截面方法。指示男性每周服用PDE5抑制剂（PDE5i）3次，如果需要，每天使用真空收缩装置（VCD）。通过多个经过验证的问卷对结果进行测量。此外，还记录了阴茎拉伸长度，副作用，对PR疗法的依从性和参与障碍。纳入了77例患者，但是只有49例在3个或更多个时间点完成了评估，并纳入了分析。该研究组的平均年龄为58.1岁（±7.7），接受了机械腹腔镜前列腺癌根治术（91.7％），并且进行了双侧神经保留手术（95.8％）。术前多数（62.5％）报告的SHIM正常，但是79％使用PDE5i。由IIEF和勃起硬度评定的勃起功能在手术后受到负面影响，在整个24个月的随访中，其参数逐渐改善。术前SHIM正常的参与者中，分别只有13.1岁和2岁的患者恢复了基线功能，分别为23.1％和28.6％。术后立即使性高潮明显减少，但是，在研究期结束时，只有37％的男性报告了高潮减弱，而没有男性报告没有性高潮。阴茎康复治疗的依从性随着时间的推移而下降。男性平均口服PDE5i 2。在12和24个月每周3次（p <0.001）。男性每周使用VCD的时间为2.3-3.9天，但随着时间的推移而下降（p = 0.014）。随着时间的推移，勃起和性高潮参数得到改善，但是大多数男性没有恢复到基线功能。尽管有全面的指导和频繁的随访计划，PDE5i和VCD的依从性仍然很差。值得注意的是，流失率很高，只有55.8％的男性在12个月时还剩下45％的男性在24个月时就完蛋了。公关依从性的最常见障碍是成本，不便和无效。PDE5i和VCD的依从性较差。值得注意的是，流失率很高，只有55.8％的男性在12个月时还剩下45％的男性在24个月时就完蛋了。公关依从性的最常见障碍是成本，不便和无效。PDE5i和VCD的依从性较差。值得注意的是，流失率很高，只有55.8％的男性在12个月时还剩下45％的男性在24个月时就完蛋了。遵守公关最常见的障碍是成本，不便和无效感。