Clinical Research And Risk Analysis Of Patients With Organic Erectile Dysfunction After Pelvic Fracture Urethral Injury

Traumatic urethral stricture is one of clinical problems in Urology.With the advancement of modern social development and urbanization,including frequent traffic accidents and falling injury,the incidence of posterior urethral injury caused by pelvic fracture is growing high.In recent years,with the developing operative theory and technology,the success rate of urethral reconstruction is higher than before.However,erectile dysfunction(ED)as one of the main Complications is most concerned about.The research aims to study the clinical characteristics in patients with male traumatic urethral stricture associated erectile dysfunction.Objective To study clinical various types of organic ED and severity in patients with pelvic fracture urethral injury and to investigate the risk of organic ED in patients with pelvic fracture urethral injury.Methods Between Dec 2013 and Jan 2016,the patients with posterior urethral strictures after suffering from pelvic fracture were included in our study.The patients were divided into three groups according to Tile’s/AO Classification(Group A: type Tile’s A fractures;Group B: type Tile’s B fractures;Group C: type Tile’s C fractures).Detailed medical history of patients was completed at admission,including patient age,injury time,past history of urethral reconstruction surgery,length and position of urethral stricture or atresia,and IIEF-5 score before and after the injury.Nocturnal penile tumescence tests(NPT,Rigiscan assessment system,continuing two nights)and pharmaceutical penile duplex ultrasound(PPDU)with intracavernous injection were performed in each patient.And further evaluations of selective Arteriography and cavernosography would be performed if necessary.According to all medical history and test results,the patients with organic ED were analyzed for the diagnosis and severity of ED.Eligible cases were enrolled in this study,and divided into two groups according to NPT Classification(Organic ED group;Non-organic ED group).Factor data were analyzed by statistical method on the including patient’s age,injury time,past history of urethral reconstruction surgery,length and position of urethral stricture or atresia,pelvic fracture type.Results 44 eligible cases were enrolled in this study(Group A: 26;Group B: 10;Group C: 8).The median age was 33.75 years old(range,22-50 years old).The interval time was 3-18 months after the injury(average 8.65 months).The average previous history of urethral reconstruction surgery was 0.8 time(range,0-3).Preoperatively patients reported average IIEF-5 score of 9.88±2.85,but they all self-reported healthy sexual function with average IIEF-5 score of 22.23±1.55.The length of urethral stricture or atresia were 2.90 cm in group A,3.60 cm in group B and 3.87 cm in group C(p<0.05).NPT tests showed that the total erectile events at night were 2.50±1.26 in group A,0.80±0.63 in group B and 0.25±0.46 in group C.Organic ED was diagnosed in 38 cases(26 in group A,10 in group B and 8 in group C).By PPDU,arterial ED,venous leakage,arteriovenous ED was diagnosed in 7 patients,18 patients and 7 patients,respectively.According to the NPT outcomes,patients were divided into two groups including organic ED group(38 cases)and non-organic ED group(6 cases).The median age was 33.97±7.68(organic ED group);32.33±7.28(non-organic ED group)years old(p>0.05).The interval time was 8.76±3.19(organic ED group);8.00±1.79(non-organic ED group)months after the injury(p>0.05).The length of urethral stricture or atresia were 3.43±0.67 cm in organic ED group,2.20±0.50 in non-organic ED group(p<0.05).On factor analysis,3 variables were significant factors for prediction of ED,namely pelvic fracture type,the position of urethral stricture,and long urethral gap.The results of analyses showed that these 3 variables were significant at odds ratios(ORs)of 6.89,3.56 and 1.96 respectively.Conclusion The incidence of Organic ED in patients with pelvic fracture urethral injury was 86%,and in such patients vascular ED accounted for 84%.Pelvic fracture urethral injury was the main factor leading to organic ED,which would probably cause erectile vascular damage.The development of ED after PFUI can be influenced by pelvic fracture type,the position of urethral stricture,and long urethral gap.No relationship was evidenced between ED and age,injury time at traumatism.