Abstract
IntroductionPelvic ring injuries, frequently caused by high energy trauma, are associated with high rates of morbidity and mortality (5–33%), often due to significant blood loss and disruption of the lumbosacral plexus, genitourinary system, and gastrointestinal system. The aim of the present study is to perform a systematic literature review on male and female sexual dysfunctions related to traumatic lesions of the pelvic ring.MethodsScopus, Cochrane Library MEDLINE via PubMed, and Embase were searched using the keywords: “Pelvic fracture,” “Pelvic Ring Fracture,” “Pelvic Ring Trauma,” “Pelvic Ring injury,” “Sexual dysfunction,” “Erectile dysfunction,” “dyspareunia,” and their MeSH terms in any possible combination. The following questions were formulated according to the PICO (population (P), intervention (I), comparison (C), and outcome (O)) scheme: Do patients suffering from pelvic fracture (P) report worse clinical outcomes (C), in terms of sexual function (O), when urological injury occurs (I)? Is the sexual function (O) influenced by the type of fracture (I)?ResultsAfter screening 268 articles by title and abstract, 77 were considered eligible for the full-text analysis. Finally 17 studies that met inclusion criteria were included in the review. Overall, 1364 patients (902 males and 462 females, M/F ratio: 1.9) suffering from pelvic fractures were collected.DiscussionPelvic fractures represent challenging entities, often concomitant with systemic injuries and subsequent morbidity. Anatomical consideration, etiology, correlation between sexual dysfunction and genitourinary lesions, or pelvic fracture type were investigated.ConclusionThere are evidences in the literature that the gravity and frequency of SD are related with the pelvic ring fracture type. In fact, patients with APC, VS (according Young-Burgess), or C (according Tile) fracture pattern reported higher incidence and gravity of SD. Only a week association could be found between GUI and incidence and gravity of SD, and relationship between surgical treatment and SD. Electrophysiological tests should be routinely used in patient suffering from SD after pelvic ring injuries.
Highlights
Pelvic ring injuries, frequently caused by high energy trauma, are associated with high rates of morbidity and mortality (5–33%), often due to significant blood loss and disruption of the lumbosacral plexus, genitourinary system, and gastrointestinal system
We considered the studies published as full-text articles in indexed journals, which investigated the association between pelvic ring injuries and sexual dysfunction
There is evidence in the literature that the gravity and frequency of sexual dysfunctions (SD) are related with the pelvic ring fracture type
Summary
Frequently caused by high energy trauma, are associated with high rates of morbidity and mortality (5–33%), often due to significant blood loss and disruption of the lumbosacral plexus, genitourinary system, and gastrointestinal system. Frequently caused by high-energy trauma, are associated with high rates of morbidity and mortality (5– 33%), often due to significant blood loss and disruption of the lumbosacral plexus, genitourinary system, and gastrointestinal system [1–4]. Genitourinary injuries (GUI) and sexual dysfunctions (SD) associated to pelvic ring disruption are the result of direct or indirect trauma [5, 6]. Urogenital system structural and functional damages could be related to the anatomical relationship between the abdominal organs, neuro-vascular structures, and International Orthopaedics (SICOT) (2021) 45:2687–2697 the pelvic ring [3]. Some authors observed a direct correlation between the Injury Severity Score (ISS) increase and the sexual disturbance incidence [7]. Some factor such as age, pelvic fracture complexity, and pubic symphysis alterations could represent erectile dysfunction risk factors after major pelvic injuries. A direct trauma on the pelvic floor or pelvic soft tissue damage (such as connective tissue, neuro-vascular structures) could lead to pelvic floor dysfunction, urogenital and neurogenic pain, and dyspareunia [10]
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