Predictors of erectile dysfunction post pelvic fracture urethral injuries: a multivariate analysis

Abstract

Objective: To learn the incidence of erectile dysfunction (ED) after pelvic fracture urethral injury (PFUI) and to identify the related risk factors.

Methods: Patients who had sustained a PFUI from 1984 to 2010 were identified from database and invited to participate in the study. All responders were queried after a minimum of 2 years from the time of trauma to assess their erectile function (EF) using the EF domain of the International Index of Erectile Function (IIEF). Medical records and imaging studies were reviewed with a focus on 6 variables that may predict ED. Univariate and multivariate analyses were used to identify parameters predictive of ED.

Results: Overall, 90 patients participated in the study, among whom 40 (44%) had ED. On univariate analysis, 4 variables were significant factors for prediction of ED, whereas on multivariate analysis only 3 factors remained strong and independent predictors, namely diastasis of pubic symphysis, lateral displacement of prostate, and long urethral gap. The results of analyses showed that these 3 variables were significant at odds ratios (ORs) of 15.9, 6.9, and 2.0, respectively.

Conclusion: The development of ED after PFUI can be predicted by 3 factors, namely diastasis of pubic symphysis, lateral prostatic displacement, and long urethral gap. Pubic diastasis has the highest predictive accuracy. A tendency for higher risk of ED could be observed after bilateral rami and Malgaigne's fractures, but they failed to reach the level of significant predictors on multivariate analysis. No relationship was evidenced between ED and age at traumatism.