Urologist communication is a primary factor leading to erectile dysfunction treatment postprostatectomy

Abstract

Abstract Background Studies have shown insufficient utilization of care for patients with erectile dysfunction (ED) after radical prostatectomy (RP). Aim The aim of this study was to evaluate variables associated with barriers to seeking and receiving ED treatment. Methods In this multicenter prospective cross-sectional study, the functional outcomes of 936 patients were assessed 10 to 15 years after RP. A total of 525 patients with ED or incontinence were asked about their treatment experiences or lack thereof. The data were analyzed using the chi-square test, t test, and multivariate logistic analyses. Outcomes Patients answered validated questionnaires regarding information sources, communication with their partner and urologist, and barriers to ED treatment. Results Of the 525 patients, 80 were not available to survey. A total of 304 patients answered the survey (response: 68.0%). A total of 246 patients had ED and were included in this study. The mean age at surgery was 64.4 ± 6.1 years, and the mean age at the time of this survey was 77.1 ± 6.2 years. The mean follow-up duration was 12.7 ± 1.5 years. Forty-six percent (n = 114 of 246) of the patients had never received ED treatment. The most important conversation partners regarding the ED were the partner (69% [n = 169 of 246]) and the urologist (48% [n = 118 of 246]). Patients who never received ED treatment were less likely to have conversations with their urologist (34% vs 60%; P < .001), had less support (51% vs 68%; P = .01), and had less interest in sex from their partner (20% vs 40%; P = .001). Communication with other groups (general practitioners, other physicians, family, friends, and the Internet) had no influence on ED treatment utilization. The most relevant barrier to receiving ED treatment was the belief that treatment would not help (65%). No interest in sex from their partner (odds ratio, 3.9) and no conversation with their urologist about ED (odds ratio, 2.9) were found to be independent predictors of not receiving ED treatment. Clinical Implications Urologists should have enhanced awareness of how to approach patients directly about their ED and actively offer them treatment options. Strengths and Limitations These results should be further validated in a multicenter, prospective study. Response bias may have affected the results. Furthermore, the current cohort was relatively old. Conclusion This study revealed that no interest in sex from one’s partner and insufficient communication with a urologist were relevant barriers to insufficient utilization of ED treatment after RP.