WCE 2017: Significance of Erection Hardness Score as a Diagnostic Tool to Assess Erectile Function Recovery in Japanese Men After Robot-Assisted Radical Prostatectomy
Dr. Yasuyoshi Okamura, a clinical fellow at Kobe University Graduate School of Medicine presents the erection hardness score (EHS) as an alternative to the IIEF-5 and standard erections sufficient for intercourse (ESI) questionnaires post-RARP. In this prospective study of 170 Japanese patients undergoing RARP as primary treatment for prostate cancer, 55.9% had a bilateral or unilateral nerve-sparing procedure. Erectile function was assessed perioperatively with both the IIEF-5 and EHS scores. Potency recovery as a primary outcome was defined as ESI (corresponding with EHS>2) and erectile function (corresponding with EHS>1).
The mean age of the cohort was 65.3 years. Pertaining to sexual function recovery was also a 23.8 kg/m2 mean BMI, 9.2 mean pre-operative IIEF-5 score, and a 1.2 mean Charlson Comorbidity Index score. Majority of patients (94.9% and 85.9%, respectively) had p-stage<pT3b and pGS<8. At 6, 12, and 24 months post-RARP, 11.9%, 21.7%, and 35.8% of patients had recovered erectile function. Of these, 3.8%, 9.8%, and 13.7% achieved ESI. Univariate and multivariate analysis showed age, pre-operative IIEF-5 score, and nerve-sparing procedure as significant indicators of potency recovery post-RARP.
While these findings do not suggest favorable erectile function recovery in this cohort of patients, the authors do note that the EHS provided a much clearer picture of potency recovery. In particular, sexually inactive patients in a more-modest Japanese cohort were less likely to score highly on the IIEF-5, with common answers being a 4 or 5 on item one and/or two and zeros or non-answers for the remainder.
Overall, erection hardness score presents as an advantageous questionnaire both for long term prediction of erectile function recovery and for follow-up in this Japanese cohort of patients. In particular, early metrics of impotency as predicted by the EHS may provide a much-needed counseling tool for those who are most likely to benefit from early intervention or therapies. Future studies analyzing EHS or percent erection hardness should be considered in larger, more diverse patient populations.
Presented by: Yasuyoshi Okamura
Authors: Yasuyoshi Okamura, Junya Furukawa, MD, PhD, Katumi Shigemura, Kenichi Harada, Nobuyoki Hinata, Takeshi Isihimura, Masato Fujisawa
Affiliation: Division of Urology, Kobe University Graduate School of Medicine kobe, Hyogo, Japan
Written by: Linda Huynh (BS), assistant research specialist, University of California, Irvine 35th World Congress of Endourology– September 12-16, 2017, Vancouver, Canada.