Author/Authors :
Blaschko, Sarah D. University of California, San Francisco - Department of Urology, USA , Sanford, Melissa T. University of California, San Francisco - Department of Urology, USA , Schlomer, Bruce J. University of California, San Francisco - Department of Urology, USA , Alwaal, Amjad University of California, San Francisco - Department of Urology, USA , Yang, Glen University of California, San Francisco - Department of Urology, USA , Villalta, Jacqueline D. University of California, San Francisco - Department of Urology, USA , Wessells, Hunter University of Washington - Department of Urology, USA , McAninch, Jack W. University of California, San Francisco - Department of Urology, USA , Breyer, Benjamin N. University of California, San Francisco - Department of Urology, USA
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.
Keywords :
Erectile dysfunction , Meta , analysis , Systematic review , Urethral disruption , Pelvic fracture
