Sexual Dysfunction in Pelvic Fracture Urethral Injury
The incidence of sexual dysfunction after Pelvic fracture is around 5-28% .
The rate increases further when there is pelvic fracture Urethral Injury.
ED in PFUI can be due to:
2.Neurogenic (Neuropraxia is temporary, Neurotmesis is permanent)
3.Mixed. (Most common)
The cavernous nerves are at 5 and 7 o clock near the prostate apex and travel around the membranous urethra as a plexus, later they enter the corpora. As the injury in PF is at bulbo membranous junction, the nerves often get damaged.
Neuropraxia or stretching of the nerves is common and may recover over 9-12 months. Neurotmesis or division of the nerves leads to permanent ED.
Koratim et el published in their series the factors to predict ED such as long gaps, lateral displacement, butterfly fractures of the pubic rami.
Neurogenic ED is be treated with PDE5, IC injections.
For arteriogenic injury, the options are Revascularization (Inferior Epigastric Artery to Dorsal penile artery) or Penile implants.
We have published the largest series of PFUI. (1)
In our series preoperatively more than 56% patients (Primary and Redo) had ED and post operatively about 63%. This matches the figures of the TURNS group.(2)
In our Unit:
We evaluate PFUI with penile doppler preoperatively in all patients whether they give history of ED or not.
After we transect bulbar urethra (bulbo urethral arteries), the distal urethra is dependent on retrograde flow. The role of dorsal penile arteries is important in the retrograde flow through the glans and penile urethra.
When we do doppler, we assess Cavernosal as well as dorsal penile arteries.
If the dorsal arteries are damaged due to previous improper pubectomy then the risk of bulbar urethral necrosis is high.
Most patients do not get reasonable erections post op with use of PDE5 inhibitors. and need penile implants.
The rate of ED in PFUI is over 60% (Primary and redo)
Judiciously performed urethroplasty does not increase the risk of iatrogenic ED by more than 5%.
Preoperative Penile doppler for corporal and dorsal penile arteries is recommended for all patients of PFUI.
1.Joshi PM, Kulkarni SB. Management of pelvic fracture urethral injuries in the developing world. World J Urol 2020;38:3027-34
2.Mazzone A, Anderson R, Voelzke BB, Vanni AJ, Elliott SP, Breyer BN, Erickson BA, Buckley J, Myers J. Sexual function following pelvic fracture urethral injury and posterior urethroplasty. Transl Androl Urol. 2021 May;10(5):2043-2050View DocumentView DocumentView Document