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Altération de la qualité de vie sexuelle des patients atteints d'un cancer de la prostate : de la reconnaissance aux actions pour améliorer leur sexualité

Abstract : Prostate cancer is the most common cancer in France (54,000 cases in 2011). Approximately 20,000 radical prostatectomies (PR) are performed per year. Despite the progress in PR over the past 20 years, the rate of post-PR erectile dysfunction varies between 30 and 90% and only 16% of operated men regain their pre-treatment erections. There is currently no validated post-prostatectomy rehabilitation protocol. Patient associations, in particular the National Association of Prostate Cancer Patients, have a very strong demand for the management of sexual problems after treatment. The objective of this thesis work was: i) to measure sexual satisfaction after radical prostatectomy; ii) to identify patients' educational needs and build an appropriate competency framework.Methods :i) Identification of the IIEF-EF cut-off score to define post-Radical Prostatectomy sexual satisfaction; ii) Study of the evolution of sexual satisfaction in men who recover erections after radical prostatectomy; iii) Development of a therapeutic education program adapted to the needs of post-PR patients: Qualitative study to identify patients' educational needs and build an appropriate competence framework.Results :A score of 24 on the IIEF-EF represents the best cut-off for defining sexual satisfaction. These data are important for the choice of the score defining "erectile recovery" in post-PR erectile rehabilitation studies and generally for the evaluation of post-PR erectile function. The quality of sexual life is systematically impacted after radical prostatectomy and in a sustainable way even if erectile function is restored. At the end of the qualitative study, two categories of patients emerged during the interviews: "sacrificing" patients and "confused" patients. The needs identified were considered essential for patients and were equivalent in terms of knowledge, "know-how" and "being". The program was built on the "Health Belief Model" (HBM Health Belief Model), using a conceptual framework for change. 9 pedagogical objectives were identified, a programme of 6 individual sessions, including one with the partner, was built.Conclusion :The quality of sexual life of patients after radical prostatectomy is profoundly and permanently affected. Improving the quality of sexual life of patients is a major challenge that our therapeutic education program must address. Altered sexual quality of life for prostate cancer patients: from recognition to actions to improve their sexuality.
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Jean-Étienne Terrier. Altération de la qualité de vie sexuelle des patients atteints d'un cancer de la prostate : de la reconnaissance aux actions pour améliorer leur sexualité. Médecine humaine et pathologie. Université de Lyon, 2019. Français. ⟨NNT : 2019LYSES031⟩. ⟨tel-02892611⟩

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