Evaluation of erectile dysfunction following pelvic fractures: A retrospective analysis

Pelvic fractures, typically resulting from high-energy trauma, are associated with substantial mortality and morbidity. Erectile dysfunction (ED) is a recognized yet underreported complication that significantly impairs the sexual, psychological, and overall quality of life in predominantly young male patients. While reported risk factors include specific fracture patterns and pelvic embolization, existing evidence remains limited and inconclusive.

To determine the incidence of ED following traumatic pelvic fractures and identify significant demographic and clinical risk factors.

This retrospective cohort study was conducted at St George Hospital, a Level 1 Trauma Centre in Sydney, Australia. Male patients with traumatic pelvic fractures admitted between June 1, 2020, and June 30, 2024, were identified from the institutional trauma registry and medical records. Incidence and risk factors for ED were analysed using univariate and multivariate logistic regression.

Of the 164 patients included, eight (4.9%) were diagnosed with ED. On univariate analysis, significant risk factors included Injury Severity Score (ISS), hospital length of stay, operative management of the fracture, and pelvic embolization. Following multivariate logistic regression, only embolization remained an independent predictor of ED (p = 0.030, OR 7.84, 95% CI 1.22-50.15).

The observed incidence of ED (4.9%) was lower than reported in the existing literature, likely reflecting systemic under-recognition. Embolization was identified as the sole independent risk factor for post-traumatic ED. Routine assessment, standardized documentation, and early urological referral, particularly for patients undergoing embolization are recommended. Future prospective research should evaluate standardized ED screening protocols and the potential protective effects of selective versus non-selective embolization.