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Versorgung der erektilen Dysfunktion nach radikaler Prostatektomie in Deutschland

Einschätzung durch den Urologen vs. Patientenbefragung

Management of erectile dysfunction after radical prostatectomy

Urologists’ assessment vs patient survey responses

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Zusammenfassung

Einleitung

Nach radikaler Prostatovesikulektomie (RPX) besteht in Abhängigkeit von der Operationstechnik bei einem Großteil der Patienten eine erektile Dysfunktion (ED), die meist auch zum Therapiewunsch führt. Ziel dieser nationalen Studie war es, die ED-Versorgung nach RPX (ohne postoperative adjuvante Therapie und ohne Rezidiv) aus Patienten- und Urologensicht gegenüberzustellen.

Material und Methoden

Im Mai 2003 wurden 1063 in Deutschland niedergelassene Urologen und 801 rezidivfreie Patienten nach RPX ohne adjuvante Therapie angeschrieben. Gefragt wurde nach erhaltener Potenz nach RPX ohne Hilfsmittel, vorhandenem Therapiewunsch, empfohlenen bzw. getesteten Therapiemöglichkeiten (oral, transurethral, Schwellkörperautoinjektionstherapie (SKAT), Vakuumerektionshilfe, Schwellkörperimplantat) sowie der langfristigen Versorgung (Rücklauf: Patienten 80%, Urologen 27%).

Ergebnisse

Ohne Hilfsmittel postoperativ GV-fähig sind nach Urologenangaben 9,1% ihrer betroffenen Patienten, jedoch nur 4,7% der befragten Betroffenen. Ein Therapiewunsch wird nach Aussage der Urologen von 46,1% ihrer Patienten geäußert, wohingegen 44,8% bei ED keinen Therapiewunsch angeben. Nach Patientenaussage wünschen 59,3% eine Therapie, nur 28,5% wollen keine Versorgung in Anspruch nehmen. Während die Urologen schätzen, dass bei 26,1% ihrer betroffenen Patienten mit Therapiewunsch langfristig keine ED-Behandlung erfolgt, sind dies nach Patientenaussage 69,7%. Nur 30,3% der Patienten nehmen nach eigenen Aussagen langfristig eine ED-Therapie wahr, während die Urologen diesen Anteil auf 73,9% schätzen. Die ED-Einstellung erfolgt nach Urologenschätzungen langfristig: oral 38,4%, MUSE® 3,6%, SKAT 37,3%, Vakuumerektionshilfe 20,4%, Schwellkörperimplantat 0,3%. Die Betroffenen selbst verwenden dagegen langfristig nachstehende Mittel: oral 19,8%, MUSE® 1,7%, SKAT 26,7%, Vakuumerektionshilfe 50,9%, Schwellkörperimplantat 0,9%. Die Urologen schätzen die Therapiezufriedenheit ihrer Patienten durchschnittlich auf 46,2%, dagegen liegt die tatsächliche Rate bei den Patienten bei 28,9%.

Schlussfolgerungen

Die Gegenüberstellung der Patienten- und Urologenaussagen zeigt eine deutlich unterschiedliche Einschätzung der ED-Situation nach RPX. Der Anteil der Patienten mit Therapiewunsch und der Anteil, der mit der Behandlung unzufriedenen Patienten, liegt aus Patientensicht deutlich höher. Dies reflektiert eine Unterversorgung der ED-Patienten nach RPX, der auch unter den aktuellen Veränderungen des Gesundheitssystems in Deutschland Rechnung zu tragen ist.

Abstract

Introduction

After radical prostatectomy (RPX) a majority of patients suffer from erectile dysfunction (ED). Most of them wish to be treated. The aim of this national study was to evaluate ED management after RPX (without any postoperative adjuvant therapy or tumor relapse) from the patient’s view compared to the urologist’s view.

Material and methods

In May 2003 we queried 1063 urologists and 801 patients following radical prostatectomy without adjuvant therapy. They were asked about preserved potency after RPX without erectile aid, existing wish for ED therapy, recommended or tested erectile aid (oral, transurethral, intracorporal, vacuum constriction device, penile implant) as well as the long-term use. Return rate: patients 80.1%, urologists 26.7%.

Results

According to the urologists’ view 9.1% of their affected patients were potent postoperatively without a device, but according to the polled patients only 4.7%. The wish to be treated for erectile dysfunction existed in the urologists’ opinion in 46.1% of their patients, while they considered that 44.8% had no wish for treatment. On the other hand, 59.3% of the patients would like to be treatedand only 28.5% did not want any kind of treatment. Regarding the long-term use of therapy for ED, the urologists thought that 26.1% of their patients did not receive therapy for the problem, and 69.7% of the patients stated they received no long-term therapy. Only 30.3% of the patients confirmed long-term therapy, while the urologists thought that 73.9% of the patients used an erectile aid. Definite therapy in the urologists’ opinion involved oral medication in 38.4%, MUSE® in 3.6%, Schwellkörperautoinjektionstherapie (SKAT) in 37.3%, erectile aid systems in 20.4%, and a prosthesis in 0.3%. Indeed 19.8% of the patients used oral medication, 1.7% MUSE®, 26.7% SKAT, 50.9% a vacuum constriction device, and 0.9% a penile implant. Considering the satisfaction of patients, urologists thought that 46.2% of the patients were satisfied with their treatment of ED, but only 28.9% of the patients were actually satisfied themselves.

Conclusions

The comparison of patients’ and urologists’ views shows a clearly different description of the ED situation after RPX. The proportion of patients with a wish for treatment and the proportion of dissatisfied patients are much higher from the patients’ view. This demonstrates an undertreatment of ED patients after RPX, which should also be taken into account under the current changes in the German health care system.

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  1. Urologische Klinik, Universität, Ulm

    K. Herkommer, S. Niespodziany, C. Zorn, J. E. Gschwend & B. G. Volkmer

  2. Urologische Klinik, Universität, Prittwitzstraße 43, 89075, Ulm

    K. Herkommer

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  3. C. Zorn
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Correspondence to K. Herkommer.

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Herkommer, K., Niespodziany, S., Zorn, C. et al. Versorgung der erektilen Dysfunktion nach radikaler Prostatektomie in Deutschland. Urologe 45, 336–342 (2006). https://doi.org/10.1007/s00120-005-0972-8

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