Evaluation of a nurse educational program for intracavernous alprostadil injections after radical prostatectomy

Objective: To evaluate a nurse educational program for penile rehabilitation after radical prostatectomy (RP) based on intracavernous alprostadil injection (IAI).

Methods: One hundred consecutive patients started IAI one month after RP under the supervision of a nurse practitioner (day 0). Patients performed the first injection (2.5 μg); they were advised to increase gradually the dose of alprostadil until having satisfactory erections. Patients having difficulties with IAI were called back by the nurse. They received a medical follow-up at the uro-oncology department at 6 months. We assessed at D0, D15 and at 6 months: the ability to complete the IAI, the occurrence of priapism, the injected doses, the recovery of sexual function (EHS and GAQ scores), and pain in erection (numeric rating scale).

Results: Eighty-one percent of patients were very satisfied with the educational program. On day 15, 93% of patients achieved IAI (mean injected dose: 5.2 μg). No priapism was noted. The treatment had ameliorated erections in 80% of cases (GAQ); 47% of patients had erections hard enough to allow penetration (EHS>2) and 39% had sexual intercourses. Pain to erection (3.9/10 on average) represented a motive of request for recall for 2/3 of the patients. At 6 months, the dropout rate was 31%; mean pain level, EHS score and injected dose were respectively 3.2/10, 2.9/4 and 8.8 μg.

Conclusions: The nurse educational program for penile rehabilitation after RP was associated with satisfactory rates of self-injection accomplishment and treatment observance. However, close and prolonged follow up was necessary because of post-IAI penile pain.