Defining and Reporting Erectile Function Outcomes After Radical Prostatectomy: Challenges and Misconceptions

Purpose

The contemporary literature pertaining to erectile dysfunction after radical prostatectomy was evaluated. The limitations of this literature are discussed and recommendations are made for the reporting of erectile function outcomes after radical prostatectomy.

Materials and Methods

A MEDLINE® literature search was conducted in February 2008 to review English language articles published on this subject from 2000 onward. The key elements in defining and reporting erectile function outcomes after radical prostatectomy that were explored included 1) study population factors, 2) population demographics, 3) means of data acquisition, 4) variability in questionnaire use, 5) temporal considerations, 6) baseline erectile function status, 7) defining adequate erectile function, and the concepts of 8) quality and 9) consistency of erection.

Results

The incidence of reported erectile dysfunction after radical prostatectomy is extremely discrepant. The rates of erectile dysfunction appear to be higher in multicenter, multisurgeon series compared to single center, single surgeon series. A total of 24 articles were culled from the literature, which are believed to be representative of the literature in this area. There was great variation in the nature of the populations studied, how data were acquired and reported, and how baseline and postoperative adequate erectile function was defined.

Conclusions

This review studies the strengths and weaknesses of the literature on erectile dysfunction after radical prostatectomy, and makes some general recommendations for investigating and reporting erectile function outcomes after radical prostatectomy.

Key Words: erectile dysfunction, prostatectomy, phosphodiesterase inhibitors, questionnaires, research design

Abbreviations and Acronyms: ED, erectile dysfunction, EF, erectile function, EPIC, Expanded Prostate Cancer Index Composite questionnaire, IIEF, International Index of Erectile Function, PCOS, prostate cancer outcomes study, PDE5i, PDE5 inhibitor, RP, radical prostatectomy, SHIM, Sexual Health Inventory for Men