IMR Press / JOMH / Volume 18 / Issue 8 / DOI: 10.31083/j.jomh1808174
Open Access Original Research
Proper Use of the International Index of Erectile Function 5 (IIEF-5) Questionnaire in Patients Undergoing Transurethral Resection of the Prostate (TURP)
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1 Department of Urology, Clínica Alemana, 7650568 Santiago, Chile
2 Faculty of Medicine, Clínica Alemana-Universidad del Desarrollo, 7610717 Santiago, Chile
3 Department of Urology, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
4 International Doctoral School, Universidad Rey Juan Carlos, 28008 Madrid, Spain
5 Pediatric Intensive Care Unit, Hospital Roberto del Río, 8380418 Santiago, Chile
6 Pediatric Intensive Care Unit, Clinica INDISA, 7520440 Santiago, Chile
*Correspondence: (Hugo Otaola-Arca)
J. Mens. Health 2022, 18(8), 174;
Submitted: 22 March 2022 | Revised: 13 April 2022 | Accepted: 21 April 2022 | Published: 12 August 2022
(This article belongs to the Special Issue Selected Papers in Men's Health)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Background: Our goal was to show how the interpretation of the IIEF-5 questionnaire can lead to a significantly different outcome and propose a modification of the possible responses of the IIEF-5 questionnaire to assess erectile function after transurethral resection of the prostate (TURP). Methods: The results of patients treated with TURP in a randomized clinical trial were analyzed under four scenarios characterized by what patients to include and how to codify the answers for statistical interpretation: scenario (A) only patients who reported sexual intercourse; scenario (B) all patients, recording zero response for patients without sexual activity as one more grade of the scoring scale; scenario (C) same as B but coding 0 as “99” (missing value); and scenario (D) all patients are included, but the zero response remains as 0 for patients who reported not having had sexual intercourse due to the “Inability to penetrate (enter) the partner due to penile flaccidity”, whereas zero response is coded as “99” in those patients reporting “Inability to penetrate (enter) the partner due to other causes”. Results: Eighty-four patients qualified for the analysis. The proportion of patients in each ED category was very similar among the four scenarios, except for the “Severe ED” category. At baseline, scenario B had 36.9% of patients categorized as “Severe ED”, scenario D 18.5%, and scenarios A and C 17.2% (p < 0.01). This relative order remained constant in all postoperative visits. The differences in “Severe ED” rates were directly correlated with the inclusion of patients without sexual activity (higher “Severe ED” rate) and the codification of zero responses (when left as zero, they increase “Severe ED” rate, whereas when coded as 99 they are not included in the analysis and “Severe ED” rates decrease). Taking scenario D as a reference, we found a significant overestimation of “Severe ED” in scenario B up to 21.4% and a slight underestimation in scenarios A and B up to –15.7%. Conclusions: Using the IIEF-5 questionnaire with options 0 and 99 (scenario D) may improve the accuracy of detecting patients with “Severe ED” in the postoperative period of TURP. Clinical Trial Registration: NCT03936244 (

International Index of Erectile Function 5 (IIEF-5)
transurethral resection of the prostate
Fig. 1.
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