Predicting risk of erectile dysfunction after pelvic fracture urethral injury in children

We sought to determine the incidence of erectile dysfunction following pelvic fracture urethral injuries in children, and to identify the related causes and risk factors.

All consecutive children who had undergone repair of a pelvic fracture urethral injury between 1980 and 2010 were invited to participate in the study. All responders were queried after a median of 13 years (range 3 to 28) following trauma to assess erectile function using the erectile function domain of the International Index of Erectile Function. Patients who had erectile dysfunction underwent penile duplex ultrasonography. Medical records and imaging studies were reviewed with a focus on 4 variables, ie pattern of pelvic fracture, pubic diastasis, prostatic displacement and urethral gap length. Univariate and multivariate analyses were used to identify parameters predictive of erectile dysfunction at puberty.

A total of 60 patients participated in the study, of whom 28 (47%) had erectile dysfunction. On univariate analysis all 4 parameters were significant predictors of erectile dysfunction, while on multivariate analysis only 2 parameters remained strong and independent predictors, namely urethral gap length 2.5 cm or greater and prostatic displacement in a lateral direction. Duplex ultrasound revealed the cause of erectile dysfunction as arteriogenic in 19 patients (76%), arteriovenogenic in 2 (8%) and likely neurogenic in 4 (16%).

For every 2 children sustaining a pelvic fracture urethral injury 1 will exhibit erectile dysfunction at puberty. The risk of erectile dysfunction is appreciably increased in the presence of a long urethral gap and/or lateral prostatic displacement. The cause of erectile dysfunction is most commonly primarily arteriogenic and less commonly neurogenic.