Abstract
ABSTRACTErectile dysfunction (ED) is a common complication of pelvic fractures. To identify the vascular and neurogenic factors associated with ED, 120 patients admitted with ED after traumatic pelvic fracture between January 2009 and June 2013 were enrolled in this study. All patients answered the International Index of Erectile Function (IIEF-5) questionnaire. Nocturnal penile tumescence (NPT) testing confirmed the occurrence of ED in 96 (80%) patients on whom penile duplex ultrasound and neurophysiological testing were further performed. Of these ED patients 29 (30%) were demonstrated only with vascular abnormality, 41 (42.7%) were detected only with neural abnormality, 26 (27.1%) revealed mixed abnormalities. Of the 55 patients (29+26) with vascular problems, 7 patients (12.7%) with abnormal arterial response to intracavernous injection of Bimix (15mg papaverine and 1mg phentolamine), 31 (56.4%) with corporal veno-occlusive dysfunction and 17 (30.9%) had both problems. Of the 67 (41+26) patients with abnormal neurophysiological outcomes, 51 (76.1%) with abnormal bulbocavernosus reflex (BCR), 20 (29.9%) with pathological pudendal nerve evoked potentials (PDEPs) and 25 (37.3%) with abnormal posterior tibial somatosensory nerve evoked potentials (PTSSEPs). Our observation indicated that neurogenic factors are important for the generation of ED in patients with pelvic fracture; venous impotence is more common than arteriogenic ED.
Highlights
Erectile dysfunction (ED) is defined as the inability to achieve or maintain an erection adequate for sexual satisfaction [1]
While knowledge from pelvic microscopic anatomy and erectile physiology provided insights for alternative pathways in the development of ED [2, 6, 7], few studies have been designed to analysis the exact pathophysiological factors in this type of ED patients [8, 9], no study was performed to differentiate the neurogenic ED from vasculogenic ED and it was just assumed that patients with normal vascular response are neurogenic ED [3, 10]; the number of the patients observed in most of the reports are not big enough which for some extent may impact the interpretation of the results [3, 11]
Bimix of 15mg papaverine and 1mg phentolamine was injected intracavernously to relax the vasculature as other reports [10], and the same evaluation criterion as above mentioned was applied; we found that ED caused by pelvic fracture had a vasculogenic etiology in 45.8% (55 of 120) of patients, of them 12.7% were subclassified as arteriogenic, 56.4% venogenic and 30.9% arteriovenogenic
Summary
Erectile dysfunction (ED) is defined as the inability to achieve or maintain an erection adequate for sexual satisfaction [1]. It has been reported that 3% of cases of ED may result from pelvic fractures or perineal blunt trauma [2]. The incidence of ED ranges from 20% to 84% in patients with urethral injury secondary to perineal trauma or pelvic fractures [3]. ED caused by pelvic fractures, especially associated with urethral injuries, is more common than previously described [2]. Even without severe urological injury, damage to the delicate vascular and nervous tissues supplying the genitalia can result in ibju | The vascular and neurogenic factors associated with ED after pelvic fractures sexual dysfunction [3, 5]. The main purpose of our study was to evaluate the vascular and neurogenic factors associated with ED in a relatively large population of patients after pelvic fracture
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