(204) Reliability of a Recalled IIEF-5 Score Collected 3 Months Post-Operatively in Assessing Pre-Operative Erectile Function in Patients Undergoing Radical Prostatectomy
Authors: Kontogiannis S , Gkeka K , Natsos A , Obaidat M , Tsounakos S , Georgopoulos P , Liatsikos E , Asimakopoulos K , Drettas P 
Published: March 2024

Abstract

Introduction
Erectile function (EF) is a major concern for the patients after radical prostatectomy (RP). The precise evaluation of EF before RP is one of the crucial prognostic factors for its recovery after surgery. Due mainly to time constraints, most urologists routinely just ask vaguely a question about EF before surgery. Also, most patients need firstly to have a clear view of their oncologic status and no incontinence before visiting a sexual medicine specialist, usually after three months. So, three months after surgery, are they reliable to report their pre-operative EF? In the literature, there are evaluations one month or six months after surgery with mixed results concerning the reliability, but there is no evaluation of the recalled EF three months after RP.

Objective
To examine if the recalled pre-operative EF three months after surgery is in agreement with the real-time pre-operative EF collected just before surgery.

Methods
We recruited consecutive patients who underwent RP and consequently visited our Sexual Rehabilitation after RP Clinic. All patients completed the IIEF-5 questionnaire (the real-time IIEF-5 score), the day before the operation. Three months after RP, they were also asked to recall their preoperative baseline erectile function, completing a second IIEF-5 score (the recalled IIEF-5 score). In both questionnaires, the target period was the last 6 months before surgery. We excluded from the study patients with major psychiatric disorders and drug or alcohol abuse. The collection of the real-time and the recalled IIEF-5 score was conducted from two different investigators. Concerning the severity of erectile dysfunction, patients were divided into five categories according to their IIEF-5 scores: severe (1–7), moderate (8–11), mild to moderate (12–16), mild (17–21), and no ED (22–25). An interrator agreement analysis in distribution was performed using the kappa statistic to determine the degree of agreement between the IIEF-5 scores.

Results
We collected data from 55 men. The mean (± standard deviation) age and PSA was 67.5 (± 5.8) years and 9.96 (± 7.24) ng/ml. The real-time pre-operative IIEF-5 mean score and the recalled pre-operative IIEF-5 mean score and standard deviation (three months after the operation) was 17.8 (± 6.3). Concerning the different categories of erectile dysfunction, most patients (60%) were classified to no or mild erectile dysfunction for the real-time IIEF-5 score and similar percentage of patients (61.8%) were classified for no or mild erectile dysfunction for the recalled IIEF-5 score. The correlation of real-time and recalled IIEF-5 score was high, as the Pearson correlation co-efficient was 0.885 (p&lt;0.001). Similar correlations were noted in the different questions of IIEF-5, too. The scatterplot created for the real-time IIEF-5 score and the recalled IIEF-5 score depicts nicely the correlation (Figure 1). In addition, the agreement between the categories of erectile dysfunction severity between the two different IIEF-5 questionnaires was substantial (kappa=0.613, p&lt;0.001), as shown vividly in Table 1.

Conclusions
Patients reliably report their pre-operative EF even three months after radical prostatectomy. This finding may make clinicians use the IIEF-5 questionnaire to evaluate the EF before surgery and therefore, guide treatment appropriately.

Disclosure
No.