Baseline Potency in Candidates for Bilateral Nerve-Sparing Radical Retropubic Prostatectomy

Salonia, Andrea; Zanni, Giuseppe; Gallina, Andrea; Saccà, Antonino; Sangalli, Mattia; Naspro, Richard; Briganti, Alberto; Farina, Elena; Roscigno, Marco; DaPozzo, Luigi F.; Rigatti, Patrìzio; Montorsi, Francesco

doi:10.1016/j.eururo.2005.12.007

Cited by 71 publications

(55 citation statements)

References 27 publications

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“…This difference did not attain statistically significance because of the relatively small study population (n = 91). the diagnosis itself can result in loss of sexual interest and activity [29][30][31][32][33]. The present study has some limitations.…”

Section: The Use Of the Iief-5 Questionnaire To Evaluate Post-rrp Edmentioning

confidence: 83%

The Use of IIEF-5 for Reporting Erectile Dysfunction Following Nerve-Sparing Radical Retropubic Prostatectomy

Albersen¹,

Joniau²,

Poppel³

2009

TOPCANJ

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Abstract:Introduction: Increased detection of organ-confined prostate cancer has led to an increased demand for nervesparing surgery. Most studies of erectile dysfunction (ED) following nerve-sparing radical prostatectomy (RRP) use single-item assessment, and potency rates differ widely among various groups. We aimed to investigate the use of the IIEF-5, a validated questionnaire, for reporting ED following RRP. Aims: To study the use of the IIEF-5 questionnaire in the evaluation of post-RRP ED, and to find possible variations in ED reporting when comparing IIEF-5 to single-item assessment. Methods: At a minimum of 18 months post-surgery, patients completed a questionnaire on erectile function that included both single-item assessment and the IIEF-5. The study included sexually active patients who reported no pre-operative ED and who did not receive adjuvant or salvage therapy. Main Outcome Measures: For the single-item assessment, potency was defined as "the ability to achieve erections firm enough for intercourse". For the IIEF-5 questionnaire, potency was defined as a score >22 (out of 25) points. Results: Ninety-one patients were included in the study. The procedures consisted of bilateral nerve-sparing (55%) or unilateral or partial bilateral nerve-sparing surgery (45%). We found a striking difference in potency rates when using either IIEF-5 score or single-item assessment for reporting of potency after RRP. The results when using the IIEF-5 questionnaire indicated that 25.5% of all patients were potent. In contrast, single-item assessment indicated a potency rate of 53.8%. Conclusions: Using the IIEF-5 questionnaire to evaluate ED following RRP results in a remarkably lower percentage of men being classified as having no ED. This might be the main reason IIEF-5 is not frequently used in the reporting of ED following radical prostatectomy. Literature search reveals that the IIEF-5 questionnaire is expected to have a higher level of validity, accuracy, and reliability, and may be more stable than single-item assessment. We think that the use of IIEF-5 in the reporting of ED following RRP enhances comparison of different series and of different treatment modalities. However, a prospective comparison between IIEF-5 and single-item assessment is needed to confirm this finding.

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Section: The Use Of the Iief-5 Questionnaire To Evaluate Post-rrp Edmentioning

confidence: 83%

The Use of IIEF-5 for Reporting Erectile Dysfunction Following Nerve-Sparing Radical Retropubic Prostatectomy

Albersen¹,

Joniau²,

Poppel³

2009

TOPCANJ

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“…This rate is very similar to the previously reported IIEF-based 50% and 43% potency rates in a prostate cancer screening population and in candidates for bilateral nerve-sparing radical prostatectomy, respectively. 27,28 Our study had several limitations. The retrospective design did not allow us to control or assess the sequence in which patients responded to the IIEF-5 and the EPIC instruments.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, our analyses included patients with a wide range of erectile function, with sexual domain scores on the EPIC ranging from 10 to 94, and the overall prevalence of pretherapy ED was similar to the prevalence reported in other published series. 27,28 Some of the absolute numbers of patients in certain cells of our cross-tabulations were relatively low. Therefore, the percentages of patients meeting a certain definition of potency provided more an estimate for the strictness of that definition than an accurate point-estimate for the pretherapy prostate cancer population.…”

Section: Discussionmentioning

confidence: 99%

Defining potency: A comparison of the International Index of Erectile Function short version and the Expanded Prostate Cancer Index Composite

Schroeck

Donatucci

Smathers

et al. 2008

Cancer

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BACKGROUND.Both the 5‐item short version of the International Index of Erectile Function (IIEF‐5) and the Expanded Prostate Cancer Index Composite (EPIC) have been used to assess erectile function. In this study, the authors compared various definitions of potency according to the IIEF‐5 and the EPIC.METHODS.Patients with prostate cancer who had completed the IIEF‐5 and the EPIC within 7 days of each other were included. The Spearman correlation coefficient (rho) was calculated to assess the relation between IIEF‐5 and EPIC sexual domain scores. Concordance of potency rates by IIEF‐5 and EPIC was assessed in cross‐tabulations. By calculating the area under the receiver operator characteristics (ROC) curve (AUC), the authors ascertained the discriminative ability of the IIEF‐5 score to identify potent men as defined by the EPIC.RESULTS.Analyzing 102 questionnaire pairs, IIEF‐5 and EPIC domain scores were found to be highly correlated (rho = 0.776). EPIC sexual domain scores ≥60 had high concordance with IIEF‐5 scores ≥17 (98%) and with nearly all single‐item definitions of potency (≥71%). However, an EPIC sexual domain score ≥80 was a very strict definition of potency, and only 54% of patients with IIEF‐5 scores ≥22 met this threshold. On the basis of ROC analysis (AUC = 0.90), an IIEF‐5 score ≥20 was identified as the ideal cutoff for defining potency and corresponded with an EPIC sexual domain score ≥60.CONCLUSIONS.IIEF‐5 and EPIC scores were highly correlated, but potency rates varied widely, depending on the definition of potency. The current results help with the interpretation of sexual function outcomes data in patients with prostate cancer. Cancer 2008. © 2008 American Cancer Society.

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“…18 However, a key issue that remains controversial is the best timing for the administration of these instruments. 19 Indeed, proportions of patients do not engage in sexual activity at all after a diagnosis of prostate cancer because of psychogenic issues. Therefore, the evaluation of sexual function at the time of hospitalization may not provide realistic results.…”

Section: Preoperative Erectile Functionmentioning

confidence: 99%

Prediction of sexual function after radical prostatectomy

Briganti

Capitanio

Chun

et al. 2009

Cancer

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Radical prostatectomy (RP) is a commonly used procedure in the treatment of clinically localized prostate cancer. For this report, the authors critically analyzed the factors associated with recovery of erectile function after surgery. A systematic review of the literature using the Medline and CancerLit databases was conducted. Keywords for the literature search included prostate cancer, radical prostatectomy, erectile dysfunction, impotence, treatment, and prophylaxis. Accurate patient selection (based on patient age, preoperative erectile function, and comorbidity profile) and adequate surgical technique (ie, the preservation of neurovascular bundles) were the major determinants of postoperative erectile function. Moreover, better results were achieved when an appropriate pharmacologic treatment using either oral or local approaches was given. Therefore, the authors concluded that, if patients are stratified correctly according to preoperative, intraoperative, and postoperative factors, then a satisfactory functional recovery may be expected after surgery. For these reasons, an ideal multivariate model predicting the restoration of erectile function after surgery should include patient, surgeon, and postsurgical treatment variables. The authors also concluded that the stratification of patients with regard to their risk of developing erectile dysfunction after surgery was feasible based on several parameters, which should be taken into account for correct patient treatment and counseling. To address this objective, accurate tools for predicting the likelihood of complete functional recovery after surgery are needed. Radical prostatectomy (RP) is used increasingly as a therapeutic option for patients who have clinically localized prostate cancer and a life expectancy 10 years. The pioneering work by Walsh and Donker 1 contributed significantly to our understanding of the surgical anatomy of the prostate and represented the basis for the subsequent development of the anatomic RP technique. The objective of this surgical approach is complete excision of the prostate to provide optimal cancer control while maintaining the integrity of the anatomic structures devoted to the functions of urinary continence and sexual potency. [2][3][4] Since the initial reports on this technique, increasing numbers of studies have reported satisfactory *Predictive Modeling in Prostate Cancer, Supplement to Cancer

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Baseline Potency in Candidates for Bilateral Nerve-Sparing Radical Retropubic Prostatectomy

Cited by 71 publications

References 27 publications

The Use of IIEF-5 for Reporting Erectile Dysfunction Following Nerve-Sparing Radical Retropubic Prostatectomy

The Use of IIEF-5 for Reporting Erectile Dysfunction Following Nerve-Sparing Radical Retropubic Prostatectomy

Defining potency: A comparison of the International Index of Erectile Function short version and the Expanded Prostate Cancer Index Composite

Prediction of sexual function after radical prostatectomy

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