IPCSG May 2019 - Dr. T. Mike Hsieh: Sexual Function Rehabilitation скачать в хорошем качестве

IPCSG May 2019 - Dr. T. Mike Hsieh: Sexual Function Rehabilitation

Dr. Hsieh (pronounced “shay”) has been with UCSD for 7 years. The principles of cancer treatment are safety, cancer control and minimizing side effects. With prostate cancer, cancer control is generally approached through surgery, radiation, or hormones (i.e.,ADT). Beyond control, preserving urinary continence and sexual function are principal goals, and are referred to by urologists as the “Trifecta.” Quality of life has become very important in patients’ choices of treatments. Potential sexual side effects after cancer treatment include erectile dysfunction, anejaculation (inability to ejaculate, with or without orgasm), penile shortening or curvature, orgasmic dysfunction, orgasm associated urine leak, and decreased desire/hormonal imbalance. Erectile dysfunction (ED, the inability to obtain a penile erection sufficient for sexual activity) is a problem for one in five men across America, and is now understood to be 90% physical, and (only) 10% psychological. Erections occur when penile erectile tissue fills with blood. There are various physical causes of ED, including diabetes, heart disease, medications, spinal injury, and hormone imbalance, apart from cancer treatment (especially in prostate, bladder ,colon and rectal cancer). Cancer treatment results in long-term ED in 40-75% of patients, due to negative effects on blood flow and/or the nerves that control erections. Other major risk factors for ED are lifestyle Issues such as depression, obesity, lack of exercise, heavy drinking, recreational drugs, and cigarette smoking. Current treatment options include hormones (testosterone replacement, often applied topically, but also by injection or implants), oral therapy with PDE inhibitors (drugs that cause penile smooth muscle relaxation, such as Viagra, Cialis or Levitra), intraurethral medication (“MUSE” suppositories), vacuum constriction devices, injections, and a penile prosthesis. Dr. Hsieh noted that oral testosterone is available in Europe, South America and Asia, but not in the US, because of negative effects on the liver.