Erectile function after radical prostatectomy: Do patients return to baseline?

Objective: The aim of this study was to assess postprostatectomy erectile function compared to preoperative status by subjective patient perception and the abbreviated International Index of Erectile Function (IIEF-5) questionnaire. Materials and methods: The study used data from a prospectively collected database and a cross-sectional, questionnaire-based study in patients following radical prostatectomy. Erectile function was assessed with the IIEF-5 and the question Is your erectile function as good as before the surgery (yes/no)''. Patients were included if they were sexually active before surgery and had at least 1 year of follow-up. The main outcome measure was the proportion of patients returning to self-perceived baseline erectile function. Secondary outcome measures included the proportion of patients returning to baseline erectile function according to the IIEF-5 and predictors of return to baseline function. Results: Questionnaires from 210 patients were available. Overall, 14 patients (6.7%) reported that their erections were as good as before surgery. Bilateral nerve-sparing was the only significant predictor of a return to baseline erectile function (p = 0.004). Forty-three patients (20.5%), who did not report use of erectile aids, showed no decline in IIEF-5 score. When including patients who used erectogenic aids, 69 (32.9%) maintained their preoperative IIEF-5 score. On multivariate analysis a low preoperative IIEF-5 score was a significant predictor of return to baseline IIEF-5 score (p<0.0001). Conclusions: Return to subjective baseline erectile function following radical prostatectomy is rare. The IIEF-5 questionnaire may not adequately reflect patients' experience. This should be considered in preoperative patient counselling.