Comparing Single-Item Assessment and IIEF-5 for Reporting Erectile Dysfunction Following Nerve-Sparing Radical Retropubic Prostatectomy
Emmanuel Weyne, Lukman Hakim, Hendrik Van Poppel, Steven Joniau and Maarten Albersen
Affiliation: Department of Urology, University Hospital Leuven, Herestraat 49, B-3000 Leuven, Belgium.
Keywords: Erectile dysfunction, prostate cancer, radical prostatectomy, nerve-sparing radical prostatectomy, IIEF-5, singleitem
Introduction: Increased detection of organ-confined prostate cancer has led to an increased demand for nerve- sparing
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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