Does management of erectile dysfunction after radical prostatectomy meet patients' expectations? Results of a national survey (REPAIR) by the French Urological association

Introduction. Little stress has been placed on patients' satisfaction with regard to management of erectile dysfunction (ED) after radical prostatectomy (RP) and on how physicians' and patients' views may differ in this respect. Aim. To assess the extent to which urologists' perceptions of their patients' expectations and the actual needs expressed by these patients coincide with regard to ED and its management. Methods. Those French urologists who provisionally accepted to participate in the survey (760/1,272; 59.7%) received a physician survey instrument, 10 patient data forms to be completed during the first 10 consultations of patients who had undergone RP less than 12 months previously, and 10 copies of a questionnaire for patients to complete. Main Outcome Measures. Patient-reported sexual activity, satisfaction with sexual activity (Male Sexual Health Questionnaire), and treatment expectations; urologists' subjective assessment of the importance given by their patients to ED; the timing they propose for starting ED treatment. Results. Overall, 535/1,272 urologists (42%) returned the physician survey instrument (45.6 +/- 8.7 years, 28-67) and 2,644 patients completed the patient questionnaire (64.0 +/- 6.1 years, 44-79). The percentage of patients having intercourse pre RP was highly age-dependent (89% at 55-59 years; 56% at >= 70 years); 70-75% of patients claimed to be satisfied with their pre-RP sexual activity. Post RP, 27-53% of patients (depending upon length of follow-up), who were sexually active pre RP, had intercourse. Only 18% (< 5 months' follow-up) or 28% (> 5 months' follow-up) were satisfied. Over half (53%)-and especially the younger patients-expected early ED treatment (1 or 3 months post RP). Agreement between patients' expectations and urologists beliefs on timing of ED treatment was poor. At the 1- or 2-month visits, 73% of patients were already finding ED frustrating. Conclusions. Erectile dysfunction is an important issue for patients who have undergone RP. Urologists tend to underestimate patients' distress and desire for early treatment.