— Український інформаційний портал урологів
(Украинский информационный портал урологов)

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Консультации уролога

Ассоциация урологов Украины
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Европейская Ассоциация Урологов - Урологический информационный портал — исследователь урологии
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Erectile function after radical prostatectomy – do patients return to baseline? Версия для печати Отправить на e-mail

 Introduction & Objectives

Variations in study methodology have resulted in controversy regarding the incidence of erectile dysfunction (ED) after radical prostatectomy (RP). The most commonly utilized questionnaire is the International Index of Erectile Function (IIEF). However, this questionnaire has not been validated specifically for the situation. The purpose of this study was to assess post-RP ED as assessed by the IIEF-5 questionnaire and by subjective patient perception.

 Material & Methods This is a sub-analysis from a cross-sectional questionnaire study in patients following RP (Frey et al, J. Sex. Med, 2014). Preoperative erectile function was evaluated using the IIEF-5. Disease characteristics and information regarding the surgeries were retrieved from a prospectively collected database. A questionnaire designed to capture information on demographics, co-morbidity, and sexual function was mailed to the participants. The questionnaire included the IIEF-5 and the question “Is your erectile function as good as before the surgery (yes/no)”. The validity of this question was confirmed by a test-retest analysis. We included men who had undergone RP at our center between 1 and 3 years before the study and who had been sexually active prior to their surgery. Descriptive statistics were performed and a multiple regression analysis controlling for nervesparing, age, time since surgery, D’Amico classification and co-morbidities was used to identify predictors of a subjective return to baseline erectile function.

 Results A total of 210 participants fulfilled the inclusion criteria. The mean age was 65 years and the mean time since surgery was 23 months. Mean preoperative IIEF-5 score was 21.7 [95% CI 20.6– 22.9]. At the time of the study it had dropped to 9.9 [95% CI 8.6 – 11.3]. Of 189 patients who did not use erectile aids preoperatively, 58 patients had started using a PDE5-I, 17 used injection therapy, 5 used MUSE, 1 used a VED and 2 had received a penile implant. Forty-nine patients (23.3%, [95% CI 18.9%– 28.5%]), who did not report use of erectile aids, showed no decline in IIEF-5 score. However, only 14 patients (6.7%, [95% CI 4.4%– 10.1%]) reported that their erections were as good as before the surgery. Bilateral nervesparing (p= 0.003) and the absence of cardiovascular disease (p= 0.04) were the only significant predictors of a subjective return to baseline erectile function.

 Conclusions Return to baseline erectile function following radical prostatectomy is a rare event. The IIEF5 questionnaire may not adequately reflect patients’ experience.

FUNDING This work was funded by the Department of Urology, Herlev Hospital, Copenghagen Denmark.

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