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

Abstract

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.

Outcome Changes after Diverse Radical Prostatectomy among Prostate Cancer Patients: Comparison of One and Five Years of Follow-Up

“…Previous studies demonstrated the good validity and reliability of this questionnaire when it was used in RP recipients [20].…”

“…Impotence occurs in 25% to 100% of patients after prostatectomy [14][15][16][17][18]. In fact, 80% to 90% of patients reported diffi culty with erections after prostatectomy [10,19], and previous studies have indicated that the recovery of sexual function may take up to two years after RP [20][21][22][23], with 60% of men still reporting sexual dysfunction two years after RP [19,24,25]. However, another study conducted by Zielinski [2], showed that fi ve years after a prostate cancer diagnosis and the RP procedure, 79.3% of men continued to experience sexual dysfunction.…”

“…The scores range from 5 to 25 [31]. In this index, ED is categorized into fi ve types based on the following scores: severe (5-7), moderate (8)(9)(10)(11), mild to moderate (12)(13)(14)(15)(16), mild (17)(18)(19)(20)(21), and no ED (22)(23)(24)(25) [31,32].…”

The effects of a nerve‐sparing procedure on urinary incontinence and sexual function among radical prostatectomy patients

“…The IIEF‐5 was developed by Rosen et al (1999) to identify and describe the severity of erectile dysfunction, with possible scores ranging from 5 to 25 (Rosen et al , 1999; Rhoden et al , 2002). Albersen et al , (2009) indicated that the IIEF‐5 questionnaire is valid, accurate and reliable and is an excellent instrument for reporting on erectile function following RP. The Cronbach's α in this study was 0·86, 0·88, 0·77, 0·90 and 0·92 at baseline (time 1), time 2, time 3, time 4 and time 5, respectively, after RP.…”

“…Since the 1980s, many urologists have employed an anatomical approach to modify their surgical procedures in an effort to diminish these complications. Since Walsh et al (1983) introduced the nerve‐sparing modification to RP, which allowed them to avoid injuring the neurovascular bundles (NVBs) that contain the cavernous nerves and vessels and to thereby preserve erectile functions, several studies have evaluated the effects of nerve‐sparing on the complications observed after RP (Catalona and Bigg, 1990; Talcott et al , 1997; Horie et al , 1999; Lee et al , 2003; Curto et al , 2006; Nakiri et al , 2008; Albersen et al , 2009).…”