Risk factors for erectile dysfunction in patients with urethral strictures secondary to blunt trauma.
BACKGROUND
Erectile dysfunction (ED) is a well-known consequence of pelvic fracture, particularly in cases involving urethral injury. There are several risk factors that may be related to ED. However, no systemic approach is used to assess erectile function secondary to urethral trauma.


OBJECTIVE
To investigate ED associated with urethral injury secondary to pelvic fracture and perineal trauma.


METHODS
Forty patients with traumatic urethral strictures secondary to blunt traumatic impact episode to the pelvis or perineum were included in our study. Pelvic fractures and urethral strictures were categorized according to injury types and radiological findings. All patients underwent nocturnal penile tumescence (NPT) monitoring, dynamic color-duplex Doppler ultrasonography (D-CDDU) before surgery. NPT monitoring was conducted again after surgery.


METHODS
The events of NPT and D-CDDU were recorded.


RESULTS
In all patients, 11 had organic ED demonstrated by NPT. Vascular pathology was identified in three of 11 patients (27%). The peak systolic velocity of cavernosal artery was lower in patients with pubic diastasis in comparison to those without diastasis (P < 0.05). Significant changes in penile length and circumference were noted in posterior urethral injury compared with anterior urethral injury during erection (P < 0.05). The erectile duration time has a similar statistical difference in two groups mentioned above. However, no significant difference could be observed in the end-to-end anatomosis procedure before and after surgery (P > 0.05).


CONCLUSIONS
The pelvic fracture type, especially pubic diastasis, is a risk factor for ED following urethral injury. Location of the stricture is also a risk factor for subsequent erectile dysfunction.
Department of Urology, Sixth People's Hospital, Jiaotong University of Shanghai, Shanghai, People's Republic of China.
Chao
C
Feng
Yue-Min
YM
Xu
Jian-Jun
JJ
Yu
Xiao-Fang
XF
Fei
Lei
L
Chen
D000293:Adolescent; D000328:Adult; D007172:Erectile Dysfunction / Q000175:diagnosis / Q000209:etiology*; D050723:Fractures, Bone / Q000150:complications; D006801:Humans; D018783:Impotence, Vasculogenic / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000293:injuries; D010413:Penis / Q000293:injuries*; D010502:Perineum / Q000293:injuries; D046548:Pubic Symphysis Diastasis / Q000175:diagnosis / Q000209:etiology; D012307:Risk Factors; D014463:Ultrasonography; D014521:Urethra / Q000293:injuries*; D014525:Urethral Stricture / Q000209:etiology*; D014949:Wounds, Nonpenetrating / Q000150:complications*; D055815:Young Adult