October 2010- Rehabilitation strategies after curative cancer treatment in prostate and testis cancer, urinary diversion and following pelvic surgery were discussed in depth during the opening plenary session today of the 10th Central European Meeting held in Bratislava, Slovakia.
Prof. George Thalmann (Switzerland) spoke on rehabilitation after urinary diversion. "Good results can be obtained by being proactive in the management of patients with an ileal bladder substitute." He also underscored the importance of checking for residual urine and UTI.
Meanwhile, Viorel Bucuras (Romania) discussed recovering continence after radical prostatectomy, mentioning the role of pelvic floor therapy and bulking agents in mild incontinence, male sling in moderate incontinence and the artificial sphincter in more serious cases of incontinence. Amongst his closing remarks were:
- The incidence of post RP incontinence has been reduced significantly;
- Therapeutic method for incontinence has seen increased efficacy;
- Pre-operative risk factors must be known and taken into account;
- Rehabilitation should be multi-factorial and individualized
- Rehabilitation procedures should be started early.
On regaining sexual function after pelvic surgery, Peter Laurinc (Slovakia) discussed the sexual function after pelvic surgery. "Even with recent advances in surgical technique and the knowledge of anatomy a significant portion of patients suffers from postoperative sexual dysfunction," he said. Laurinc added that thorough knowledge of anatomy may result in improved postoperative outcomes. He also said that outcome of surgery is highly dependent of surgeon's skill level. Moreover, he said that PDE5-1 administration has shown a positive effect on key functional and structural parameters of the cavernous tissue in the animal model.
Sexual issues after curative therapy of testicular cancer was the focus of a lecture by Z. Kopa (Hungary). Amongst his key remarks were: testicular cancer patients regardless of what treatment they receive, have significant increased risk of erectile dysfunctions, ejaculatory dysfunction and orgasmic dysfunction; the importance of sexual dysfunction is greater than what was expected before.
He also noted that studies have shown that two-thirds of testicular cancer patients experience a need for information concerning sexuality, and that one-fifth experience a need for support on this matter.
Gero Kramer of Vienna, Austria, on the other hand, emphasized the importance of closely monitoring the side effects of aggressive chemotherapy. His lecture in managing the sequence of aggressive chemotherapy mentioned the detrimental effects of radiation and chemotherapeutic drugs such as decotaxel. He added that docetaxel induced toxicity continues to be a substantial problem and that it is underestimated and under-reported.
"Aggressive chemotherapy requires a multidisciplinary team but urologists are in," said Kramer in his concluding remarks as he underscored that urologists have to be familiar with the complications in chemotherapy. "I am sure that the treatment picture will fundamentally change in the next 15 years,"he added.