Risk Stratification for Erectile Dysfunction After Pelvic Fracture Urethral Injuries

Area of Science:

• Urology
• Trauma Surgery
• Sexual Health

Background:

• Pelvic fractures are severe injuries often associated with significant morbidity.
• Erectile dysfunction (ED) is a potential complication following pelvic trauma.
• The specific impact of urethral injuries on ED in pelvic fracture patients requires further investigation.

Purpose of the Study:

• To compare the incidence and severity of ED in patients with pelvic fractures, with and without urethral injuries.
• To identify risk factors associated with ED in this patient population.

Main Methods:

• Retrospective review of male patients treated for pelvic fractures between 2005 and 2016 at a Level 1 trauma center.
• Assessment of post-injury ED using the International Index of Erectile Function (IIEF-5) questionnaire via telephone interviews.
• Review of pre-injury ED, post-injury symptoms, and medical history.

Main Results:

• Of 118 eligible patients, 50 (42%) completed the IIEF-5 questionnaire (29 with pelvic fractures alone, 21 with pelvic fracture urethral injuries - PFUIs).
• New-onset ED was numerically higher in the PFUI group (57%) compared to the pelvic fracture alone group (38%).
• Patients with PFUIs reported significantly lower IIEF-5 scores, indicating more severe ED (13 vs. 18, P=.05).

Conclusions:

• Erectile dysfunction is more severe in patients with pelvic fracture urethral injuries compared to those with pelvic fractures alone.
• Urethral injury may serve as a marker for extensive pelvic trauma and neurovascular injury, rather than being the direct cause of ED.
• Further prospective studies are needed to confirm these findings and stratify risk factors for ED in pelvic fracture patients.