The incidence of erectile dysfunction after pelvic fracture urethral injury

A systematic review and meta-analysis

Sarah D. Blaschko, Melissa T. Sanford, Bruce J. Schlomer, Amjad Alwaal, Glen Yang, Jacqueline D. Villalta, Hunter Wessells, Jack W. McAninch, Benjamin N. Breyer

Research output: Contribution to journalArticle

16 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)68-74
Number of pages7
JournalArab Journal of Urology
Volume13
Issue number1
DOIs
StatePublished - Mar 1 2015

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Erectile Dysfunction
Meta-Analysis
Incidence
Wounds and Injuries
PubMed
Confidence Intervals

Keywords

  • Erectile dysfunction
  • Meta-analysis
  • Pelvic fracture
  • Systematic review
  • Urethral disruption

ASJC Scopus subject areas

  • Urology

Cite this

The incidence of erectile dysfunction after pelvic fracture urethral injury : A systematic review and meta-analysis. / Blaschko, Sarah D.; Sanford, Melissa T.; Schlomer, Bruce J.; Alwaal, Amjad; Yang, Glen; Villalta, Jacqueline D.; Wessells, Hunter; McAninch, Jack W.; Breyer, Benjamin N.

In: Arab Journal of Urology, Vol. 13, No. 1, 01.03.2015, p. 68-74.

Research output: Contribution to journalArticle

Blaschko, SD, Sanford, MT, Schlomer, BJ, Alwaal, A, Yang, G, Villalta, JD, Wessells, H, McAninch, JW & Breyer, BN 2015, 'The incidence of erectile dysfunction after pelvic fracture urethral injury: A systematic review and meta-analysis', Arab Journal of Urology, vol. 13, no. 1, pp. 68-74. https://doi.org/10.1016/j.aju.2014.09.004
Blaschko, Sarah D. ; Sanford, Melissa T. ; Schlomer, Bruce J. ; Alwaal, Amjad ; Yang, Glen ; Villalta, Jacqueline D. ; Wessells, Hunter ; McAninch, Jack W. ; Breyer, Benjamin N. / The incidence of erectile dysfunction after pelvic fracture urethral injury : A systematic review and meta-analysis. In: Arab Journal of Urology. 2015 ; Vol. 13, No. 1. pp. 68-74.
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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.",
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AU - Blaschko, Sarah D.

AU - Sanford, Melissa T.

AU - Schlomer, Bruce J.

AU - Alwaal, Amjad

AU - Yang, Glen

AU - Villalta, Jacqueline D.

AU - Wessells, Hunter

AU - McAninch, Jack W.

AU - Breyer, Benjamin N.

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N2 - 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.

AB - 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.

KW - Erectile dysfunction

KW - Meta-analysis

KW - Pelvic fracture

KW - Systematic review

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