Public Health Department, Henri Mondor Teaching Hospital, Créteil, France; Laboratoire d'Investigation Clinique, EA 4393, Université Paris Est Créteil, Créteil, France.
J Sex Med. 2014 Aug;11(8):2109-18. doi: 10.1111/jsm.12584. Epub 2014 May 20.
Erectile dysfunction (ED) affects quality of life in patients treated by radical prostatectomy (RP). The Erection Hardness Score (EHS) is a single-item scale that has demonstrated good psychometric properties for assessing erectile function (EF) in patients treated by sildenafil, but its applicability to other treatment contexts has not yet been tested.
This study aims to test the validity and time and treatment responsiveness of the EHS to assess ED in men with post-RP ED treated with alprostadil injections.
This is a 1-year follow-up cohort study of 75 patients treated by RP for localized prostate cancer in a urology department setting between January 2007 and December 2008. Data were prospectively collected at 6 and 12 months post-RP.
The EHS, the International Index of Erectile Function (IIEF) reference questionnaire, the Global Assessment Questionnaire (GAQ), and Numeric Pain Scale (NPS) were collected. Convergent validity (Spearman correlation coefficients with IIEF domains), known-groups validity (comparing EHS scores across ED severity groups), time and treatment responsiveness (effect size with/without treatment and over the follow-up period), and predictive ability (area under the receiver operating characteristics curve [AUC-ROC]) were analyzed for this study.
The EHS showed good convergent validity (all Spearman coefficients significant at the P<0.05 level), adequate known-groups validity (global differentiation between IIEF-EF severity groups; P<0.001), and treatment responsiveness (effect size: +1.8 [6 months], +2.1 [12 months]), but limited time responsiveness and predictive ability of the EHS for a normal EF at 12 months follow-up when compared with the IIEF-EF domain (AUC-ROC: 0.72 vs. 0.85; P<0.01).
Our findings support the overall good psychometric properties of the EHS in patients with post-RP ED treated with alprostadil injections. However, evidence for limited predictive validity and responsiveness to change over time should be considered for its use in clinical follow-up in this population.
勃起功能障碍（ED）会影响接受根治性前列腺切除术（RP）治疗的患者的生活质量。勃起硬度评分（EHS）是一种单项评分量表，已被证明可很好地评估接受西地那非治疗的患者的勃起功能（EF），但其在其他治疗环境中的适用性尚未得到验证。
本研究旨在测试 EHS 评估接受前列腺素 E1 注射治疗的 RP 后 ED 男性的 ED 的有效性、时间和治疗反应性。
这是一项在泌尿科环境中于 2007 年 1 月至 2008 年 12 月对接受局部前列腺癌 RP 治疗的 75 例患者进行的为期 1 年的随访队列研究。数据在 RP 后 6 个月和 12 个月时进行前瞻性收集。
收集了 EHS、国际勃起功能指数（IIEF）参考问卷、全球评估问卷（GAQ）和数字疼痛量表（NPS）。分析了 EHS 的汇聚效度（与 IIEF 各领域的斯皮尔曼相关系数）、已知群体效度（比较 ED 严重程度组的 EHS 评分）、时间和治疗反应性（治疗时和随访期间的效应量大小）以及预测能力（接受者操作特征曲线下面积 [AUC-ROC]）。
EHS 具有良好的汇聚效度（所有斯皮尔曼系数在 P<0.05 水平均有显著意义）、足够的已知群体效度（IIEF-EF 严重程度组之间的整体差异；P<0.001）和治疗反应性（效应量：6 个月时为+1.8，12 个月时为+2.1），但与 IIEF-EF 域相比，EHS 在 12 个月随访时对正常 EF 的时间反应性和预测能力有限（AUC-ROC：0.72 比 0.85；P<0.01）。
我们的研究结果支持 EHS 在接受前列腺素 E1 注射治疗的 RP 后 ED 患者中具有良好的整体心理测量特性。然而，对于其在该人群的临床随访中的有限预测效度和对随时间变化的反应性，应加以考虑。
