MP9-12 PREDICTING RISK OF ERECTILE DYSFUNCTION FOLLOWING PELVIC FRACTURE URETHRAL INJURY DURING CHILHOOD

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery III1 Apr 2014MP9-12 PREDICTING RISK OF ERECTILE DYSFUNCTION FOLLOWING PELVIC FRACTURE URETHRAL INJURY DURING CHILHOOD Mamdouh Koraitim Mamdouh KoraitimMamdouh Koraitim More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.500AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES It has been reported that erectile dysfunction (ED) is a common complication after pelvic fracture urethral injury (PFUI). However, almost all studies have been concerned with adult patients at the time of injury. We thought to study the incidence of postpubertal ED following PFUI during childhood, as well as to identify the related risk factors. METHODS All patients who had undergone repair of a PFUI from 1980 to 2010, and aged <15 years at the time of injury and aged >18 years at the time of assessment, were identified from our database. Patients were invited by mail to participate in the study. Responding patients were asked to answer a brief questionnaire consisting of 6 questions that were designed to assess erectile experience within the past 4 weeks. This questionnaire is the erectile function (EF) domain of the International Index of Erectile Function (IIEF). Based on the total score of 30 of the EF domain, the score was calculated for every patient. Medical records and imaging studies were reviewed with a focus on 4 variables: pattern of pelvic fracture, presence of pubic diastasis, displacement of the prostate, and length of urethral gap. RESULTS Overall, 51 patients participated in the study. The mean age of patients at the time of pelvic trauma was 10 years (range 3 to <15). Of the patients, 24 (47%) exhibited ED at puberty with the majority (21 patients, 88%) reporting severe ED (score 6 -10). Single ramus fracture was found in 18 patients and ipsilateral ischiopubic rami fracture in 21, of whom 3 (17%) and 9 (43%) exhibited ED, respectively. Bilateral 2 or more rami fracture and ipsilateral rami fracture associated with disruption of sacroiliac joint (Malgaigne’s fracture) was found in 6 patients each, all 12 (100%) exhibited ED. Of 12 patients with pubic diastasis 9 (75%) developed ED, and of 39 patients with intact symphysis pubis 15 (38%) developed ED. Of 21 patients having prostatic displacement in superior and lateral directions 18 (86%) exhibited ED, while of 30 patients having superior prostatic displacement 6 (20%) had ED. The mean length of urethral gap of patients with normal EF was 1.8 cm (range 1 – 2.5), while that of impotent patients was 3.9 cm (range 2.5 – 6). CONCLUSIONS The prognosis to the parents of a child who sustains a PFUI must remain guarded until the patient attains a postpubertal status. About half of the patients exhibit ED at puberty. The risk of ED is increased in the presence of a long urethral gap, bilateral pubic rami fracture, Malgaigne’s fracture, pubic diastasis, and lateral prostatic displacement. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e126 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Mamdouh Koraitim More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...