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Original Research

Open Access Special Issue

Proper Use of the International Index of Erectile Function 5 (IIEF-5) Questionnaire in Patients Undergoing Transurethral Resection of the Prostate (TURP)

  • Hugo Otaola-Arca1,2,3,4,*,
  • Adriana E. Cabrera-Chamba3,4,
  • Carmen Niño-Taravilla5,6,
  • Francisco J Osorio-Martini1,2,

1Department of Urology, Clínica Alemana, 7650568 Santiago, Chile

2Faculty of Medicine, Clínica Alemana-Universidad del Desarrollo, 7610717 Santiago, Chile

3Department of Urology, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain

4International Doctoral School, Universidad Rey Juan Carlos, 28008 Madrid, Spain

5Pediatric Intensive Care Unit, Hospital Roberto del Río, 8380418 Santiago, Chile

6Pediatric Intensive Care Unit, Clinica INDISA, 7520440 Santiago, Chile

DOI: 10.31083/j.jomh1808174 Vol.18,Issue 8,August 2022 pp.1-6

Published: 31 August 2022

(This article belongs to the Special Issue Selected Papers in Men's Health)

*Corresponding Author(s): Hugo Otaola-Arca E-mail:


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); questionnaire; transurethral resection of the prostate

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Hugo Otaola-Arca,Adriana E. Cabrera-Chamba,Carmen Niño-Taravilla,Francisco J Osorio-Martini. Proper Use of the International Index of Erectile Function 5 (IIEF-5) Questionnaire in Patients Undergoing Transurethral Resection of the Prostate (TURP). Journal of Men's Health. 2022. 18(8);1-6.


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[7] Otaola-Arca H, Álvarez-Ardura M, Molina-Escudero R, Fer-nández MI, Páez-Borda Á. A prospective randomized study comparing bipolar plasmakinetic transurethral resection of the prostate and monopolar transurethral resection of the prostate for the treatment of Benign Prostatic Hyperplasia: efficacy, sex-ual function, Quality of Life, and complications. International Brazilian Journal of Urology. 2021; 47: 131–44.

[8] Otaola Arca H. Bipolar Plasmakinetic TURP Vs Monopolar TURP in the Treatment of Lower Urinary Tract Symptoms 2018. Available at: (Accessed: 19 May 2021).

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