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Re: What is the Definition of a Satisfactory Erectile Function After Bilateral Nerve Sparing Radical Prostatectomy?
SOCIOECONOMIC FACTORS, UROLOGICAL EPIDEMIOLOGY AND PRACTICE PATTERNS
consultation with a pharmacist. I am not convinced, given the known drug interactions of sildenafil, its side effects and the potential for inappropriate over-the-counter use. David F. Penson, M.D., M.P.H.
Re: What is the Definition of a Satisfactory Erectile Function After Bilateral Nerve Sparing Radical Prostatectomy? A. Briganti, A. Gallina, N. Suardi, U. Capitanio, M. Tutolo, M. Bianchi, A. Salonia, R. Colombo, V. Di Girolamo, J. I. Martinez-Salamanca, G. Guazzoni, P. Rigatti and F. Montorsi Urological Research Institute, Department of Urology, Vita-Salute University, Milan, Italy J Sex Med 2011; 8: 1210 –1217.
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 ⱖ 26) and reached an IIEF-EF ⱖ 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 ⱖ 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 ⱖ 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 ⱖ 26 (8.1, 8.1, and 10.6, 11.4; all P ⱖ 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 ⱕ 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 ⱖ 22 might represent a reliable score for defining EF recovery after BNSRP. Editorial Comment: Somewhat surprisingly, one of the greatest challenges in prostate cancer outcomes research is defining potency and continence postoperatively. Some researchers use a return to baseline approach, while others use an absolute numerical threshold to define these outcomes. The problem with the threshold approach is figuring out what the right threshold is. This study informs this debate, at least for people who use the International Index of Erectile Function to assess sexual outcomes. The results of this report indicate that in men who were potent preoperatively, defined as having an IIEF score of greater than 26, a cutoff of 22 is appropriate to define postoperative potency. This threshold is higher than the commonly used threshold of 17, which has been suggested previously. While this information is useful for researchers, clinicians need to remember that each patient has individual expectations before and following surgery, which will strongly influence patient satisfaction with the procedure. It is best to use the most conservative estimates when counseling a patient preoperatively. This approach helps men set reasonable expectations for the postoperative survivorship experience. To this end, studies using the higher threshold for potency suggested in this report are probably more helpful for counseling patients in the decision making process. David F. Penson, M.D., M.P.H.
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consultation with a pharmacist. I am not convinced, given the known drug interactions of sildenafil, its side effects and the potential for inappropriate over-the-counter use. David F. Penson, M.D., M.P.H.
Re: What is the Definition of a Satisfactory Erectile Function After Bilateral Nerve Sparing Radical Prostatectomy? A. Briganti, A. Gallina, N. Suardi, U. Capitanio, M. Tutolo, M. Bianchi, A. Salonia, R. Colombo, V. Di Girolamo, J. I. Martinez-Salamanca, G. Guazzoni, P. Rigatti and F. Montorsi Urological Research Institute, Department of Urology, Vita-Salute University, Milan, Italy J Sex Med 2011; 8: 1210 –1217.
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 ⱖ 26) and reached an IIEF-EF ⱖ 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 ⱖ 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 ⱖ 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 ⱖ 26 (8.1, 8.1, and 10.6, 11.4; all P ⱖ 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 ⱕ 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 ⱖ 22 might represent a reliable score for defining EF recovery after BNSRP. Editorial Comment: Somewhat surprisingly, one of the greatest challenges in prostate cancer outcomes research is defining potency and continence postoperatively. Some researchers use a return to baseline approach, while others use an absolute numerical threshold to define these outcomes. The problem with the threshold approach is figuring out what the right threshold is. This study informs this debate, at least for people who use the International Index of Erectile Function to assess sexual outcomes. The results of this report indicate that in men who were potent preoperatively, defined as having an IIEF score of greater than 26, a cutoff of 22 is appropriate to define postoperative potency. This threshold is higher than the commonly used threshold of 17, which has been suggested previously. While this information is useful for researchers, clinicians need to remember that each patient has individual expectations before and following surgery, which will strongly influence patient satisfaction with the procedure. It is best to use the most conservative estimates when counseling a patient preoperatively. This approach helps men set reasonable expectations for the postoperative survivorship experience. To this end, studies using the higher threshold for potency suggested in this report are probably more helpful for counseling patients in the decision making process. David F. Penson, M.D., M.P.H.
1379