title: Erectile function after radical prostatectomy: Do patients return to baseline?
abstract: 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.
  
  
  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.
authors.affiliation: a Department of Urology , Herlev Hospital , Herlev , Denmark ;|b Department of Urology , Roskilde Hospital , Roskilde , Denmark.
authors.forename: Mikkel
authors.initials: M
authors.lastname: Fode
authors.affiliation: a Department of Urology , Herlev Hospital , Herlev , Denmark ;
authors.forename: Anders
authors.initials: A
authors.lastname: Frey
authors.affiliation: a Department of Urology , Herlev Hospital , Herlev , Denmark ;
authors.forename: Henrik
authors.initials: H
authors.lastname: Jakobsen
authors.affiliation: a Department of Urology , Herlev Hospital , Herlev , Denmark ;
authors.forename: Jens
authors.initials: J
authors.lastname: Sønksen
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D007172:Erectile Dysfunction / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010410:Penile Erection; D011183:Postoperative Complications / Q000209:etiology*; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000601:surgery*; D020127:Recovery of Function
keywords: Erectile dysfunction; IIEF-5; patient perception; prostate cancer; radical prostatectomy; sexual dysfunction