title: The incidence of erectile dysfunction after pelvic fracture urethral injury: A systematic review and meta-analysis.
abstract: BACKGROUND
  Pelvic fracture urethral injury (PFUI) is associated with a high risk of erectile dysfunction (ED). The effect of the type of posterior urethral disruption repair on erectile function has not been clearly established. We systematically reviewed and conducted a meta-analysis of the proportion of patients with ED at (i) baseline after pelvic fracture with PFUI, (ii) after immediate primary realignment, and (iii) after delayed urethroplasty.
  
  
  METHODS
  Using search terms for primary realignment or urethroplasty and urethral disruption, we systematically reviewed PubMed and EMBASE. A meta-analysis of the proportion of patients with ED was conducted assuming a random-effects model.
  
  
  RESULTS
  Of 734 articles found, 24 met the inclusion criteria. The estimate of the proportion (95% confidence interval) of patients with ED after (i) PFUI was 34 (25-45)%, after (ii) immediate primary realignment was 16 (8-26)%, and after (iii) delayed urethroplasty was an additional 3 (2-5)% more than the 34% after pelvic fracture in this cohort.
  
  
  CONCLUSIONS
  After pelvic fracture, 34% of patients had ED. After primary endoscopic alignment, patients had a lower reported rate of ED (16%). Delayed urethroplasty conferred an additional 3% risk above the 34% associated with PFUI alone, with 37% of patients having de novo ED. The difference in de novo ED after primary endoscopic alignment vs. delayed urethroplasty is probably due to reporting differences in ED and/or patients with less severe injury undergoing primary realignment.
authors.affiliation: Department of Urology, University of California, San Francisco, CA, USA.
authors.forename: Sarah D
authors.initials: SD
authors.lastname: Blaschko
authors.affiliation: Department of Urology, University of California, San Francisco, CA, USA.
authors.forename: Melissa T
authors.initials: MT
authors.lastname: Sanford
authors.affiliation: Department of Urology, University of California, San Francisco, CA, USA.
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Schlomer
authors.affiliation: Department of Urology, University of California, San Francisco, CA, USA.
authors.forename: Amjad
authors.initials: A
authors.lastname: Alwaal
authors.affiliation: Department of Urology, University of California, San Francisco, CA, USA.
authors.forename: Glen
authors.initials: G
authors.lastname: Yang
authors.affiliation: Department of Urology, University of California, San Francisco, CA, USA.
authors.forename: Jacqueline D
authors.initials: JD
authors.lastname: Villalta
authors.affiliation: Department of Urology, University of Washington, Seattle, WA, USA.
authors.forename: Hunter
authors.initials: H
authors.lastname: Wessells
authors.affiliation: Department of Urology, University of California, San Francisco, CA, USA.
authors.forename: Jack W
authors.initials: JW
authors.lastname: McAninch
authors.affiliation: Department of Urology, University of California, San Francisco, CA, USA.
authors.forename: Benjamin N
authors.initials: BN
authors.lastname: Breyer
keywords: ED, erectile dysfunction; Erectile dysfunction; IIEF, International Index of Erectile Function; Meta-analysis; PFUI, pelvic fracture urethral injury; Pelvic fracture; Systematic review; Urethral disruption