Risk Stratification for Erectile Dysfunction After Pelvic Fracture Urethral Injuries

Abstract

To compare the frequency and severity of erectile dysfunction (ED) among pelvic fracture patients with and without urethral injuries and to identify potential risk factors for ED in the setting of pelvic fracture injury. A retrospective review was conducted of male patients treated for pelvic fractures with and without urethral injuries at a Level 1 trauma center between 2005 and 2016. The International Index of Erectile Function (IIEF-5) questionnaire was administered to patients by telephone to assess post-injury ED. Additional questions about pre-injury ED, post-injury symptoms, and past medical history were reviewed. Fifty patients (42%, n = 118) responded to the IIEF-5 questionnaire: 29 with pelvic fractures alone and 21 with PFUIs. We observed a numerical increase in frequency of new onset ED in patients with pelvic fracture urethral injuries (PFUIs) (n = 12, 57%) compared with patients with pelvic fractures alone (n = 11, 38%) (P = .3). Patients with PFUIs reported lower IIEF-5 scores (ie worse ED) than patients with pelvic fractures alone (13 versus 18, P = .05). There were no significant differences in potential risk factors between the 2 groups on univariate analyses. ED was more severe following PFUI than pelvic fracture alone. We suspect that urethral injury is not the direct cause of ED, but rather a surrogate for extensive pelvic injury and risk for neurovascular injury. A larger prospective analysis is warranted to clarify this hypothesis and to further stratify risk factors for developing ED in pelvic fracture patients with and without urethral injuries.