IIEF-15 Limitations in Preoperative Evaluation for Prostate Surgery with Ultrasound Insights

The International Index of Erectile Function-15 (IIEF-15) and its shorter versions are widely used to assess erectile function in patients undergoing prostate surgery. However, they present significant limitations: they fail to account for current erectile dysfunction therapies, focus mainly on penetrative activity, and assess only sexual activity within the past four weeks. These constraints can misclassify men with normal erectile function but no recent sexual activity as having severe erectile dysfunction (ED). In a study involving 178 patients undergoing robotic-assisted radical prostatectomy (RARP) or benign prostatic hyperplasia (BPH) surgery, 55.1% reported no sexual activity in the four weeks preceding IIEF-15 administration. Among these, 38.8% had normal erectile function based on item 15 of the questionnaire. The Erectile Function (EF) domain scores differed significantly between those with (22.5 ± 6.4) and without (3.02 ± 1.5) recent sexual activity. Factors such as age and marital status, including a higher prevalence of widowed or divorced individuals in the non-active group, were significant predictors of sexual inactivity. Multivariate logistic regression revealed age as an independent predictive factor for the absence of recent sexual activity. No significant differences were observed between patients undergoing RARP and those treated for BPH. The study highlights the limitations of the IIEF-15 in accurately assessing erectile function in preoperative settings, particularly in older individuals. Integrating ultrasound imaging into patient evaluations may offer valuable complementary data to understand erectile function more comprehensively. Reporting the percentage of sexually inactive patients is crucial for accurate research findings and clinical assessments, reducing the risk of misclassification in older populations.