73 The Value of the International Index of Erectile Function (IIEF) in Characterizing the Erectile Function in Patients with Peyronie's Disease
Authors: Greenberg JW , Soubra A , Kim J , Pincus J , Ottaiano N , Natale C , Nguyen HMT , Sandberg ML , Almajed W , Sikka S , Hellstrom WJ 
Published: April 2022

ABSTRACT

Introduction
Peyronie's Disease (PD) is characterized by physical deformity in the penis that often has a negative impact on the sexual relationship of the patient and his partner. The International Index of Erectile Function (IIEF) is a standardized patient questionnaire used to measure various aspects of erectile performance and the severity of erectile dysfunction. IIEF accuracy in patients with Peyronie's disease has been criticized as the questions that compromise this tool inquire about sexual activity and intercourse in the patient over the past 30 days, not considering the fact that those patients are able to achieve adequate erection for intercourse but do not engage either due to physical difficulty due to curvature or psychological stress, hence misrepresenting the degree of erectile dysfunction.

Objective
In this study, we correlate the IIEF score domain with the presence of vascular abnormalities on penile duplex doppler ultrasound (PDDU) during the evaluation of patients for PD.

Methods
We evaluate all patients presenting with symptoms suggestive of PD with a PDDU for better counseling on different treatment options. The IIEF questionnaire is filled at the beginning of each study. Arterial insufficiency is characterized by peak systolic velocity (PSV) less than 30 ml/sec, while venous leak is characterized by end-diastolic velocity (EDV) more than 5 ml/sec. Those measurements are obtained at 10, 15 and 20 min after injecting intracevrnosal vasoactive agent, while recording the tumescence and rigidity at each time point. In addition, we correlate the severity of IIEF score with the prevalence of vascular abnormalities detected in the PDDU study.

Results
540 consecutive patients between January 2016 and December 2020 were included in this study. The mean age of the cohort was 55.1 years. The average curvature was 53.3 degrees, with mean tumescence and rigidity achieved 90% and 70.6%, respectively. Graph 1 shows the distribution of the different vascular abnormalities detected on the PDDU in each category of IIEF abnormality. There is a clear decreasing trend of finding non-vascular abnormalities as the IIEF value decrease from None to Severe (Figure 1). Additionally, there is concomitant rise in the amount of arterial insufficiency and venous leak (counting venous leak and mixed etiology) as the severity measured on IIED questionnaire increases.

Conclusions
While IIEF questionnaire has been criticized in patients with PD as being an inaccurate assessment of erectile function, it seems to still be of a value and roughly correlates with PDDU findings. After analyzing data from our cohort, IIEF has the potential assist in treatment decision making as a screening tool for need of additional tests with higher specificity.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Endo Pharma