What is the definition of a satisfactory erectile function after bilateral nerve sparing radical prostatectomy?

INTRODUCTION: Different cut-offs of the erectile function (EF) domain of the International Index of Erectile Function (IIEF) have been used as definition of postoperative EF recovery.

AIM: To test the correlation between patient satisfaction and IIEF-EF domain score cut-offs.

MAIN OUTCOME MEASURE: The IIEF was used to evaluate EF and satisfaction before and after bilateral nerve sparing radical prostatectomy (BNSRP).

METHODS: The study included 165 consecutive patients treated with retropubic BNSRP at a single institution. All patients had normal preoperative EF (IIEF-EF ≥ 26) and reached an IIEF-EF ≥ 17 following surgery. Complete data included EF, intercourse (IS), and overall satisfaction (OS) assessed by the corresponding domains of the IIEF administered prior and after surgery. Patients were divided into three groups according to the highest IIEF-EF score reached postoperatively, namely 17-21 (group 1), 22-25 (group 2), and ≥ 26 (group 3). One-way analysis of variance was used to compare IIEF-OS and IIEF-IS domain scores at the time the EF end point was reached. The same analyses were repeated separately in those patients with a complete EF recovery after surgery (group 3).

RESULTS: Mean preoperative IIEF-OS and IIEF-IS domain score was 8.4, 8.8, 8.7 and 11.6, 11.8, 11.9 in group 1, 2, 3, respectively (all P ≥ 0.3). After a mean follow-up of 26.7 months, mean postoperative IIEF-OS and IIEF-IS domain scores assessed at the time of EF recovery were comparable for patients reaching an IIEF-EF of 22-25 and for patients scoring postoperatively ≥ 26 (8.1, 8.1, and 10.6, 11.4; all P ≥ 0.3). However, mean IIEF-OS and IIEF-IS domain scores of these patients were significantly higher as compared to patients reaching an IIEF-EF domain score < 22 (6.3 and 8.4, respectively; all P ≤ 0.006). Similar results were achieved considering only those patients (group 3) who had complete EF recovery after surgery.

CONCLUSIONS: We demonstrated that in preoperatively fully potent patients treated with BNSRP a lower satisfaction is expected when an IIEF-EF cut-off of 17 is used. Conversely, no difference was found using a cut-off of 22 or 26. Therefore, our results support that a cut-off of IIEF-EF ≥ 22 might represent a reliable score for defining EF recovery after BNSRP.