Blaschko Sarah D, Sanford Melissa T, Schlomer Bruce J, Alwaal Amjad, Yang Glen, Villalta Jacqueline D, Wessells Hunter, McAninch Jack W, Breyer Benjamin N
Department of Urology, University of California, San Francisco, CA, USA.
Department of Urology, University of Washington, Seattle, WA, USA.
Arab J Urol. 2015 Mar;13(1):68-74. doi: 10.1016/j.aju.2014.09.004. Epub 2014 Oct 16.
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.
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.
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.
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.
骨盆骨折尿道损伤（PFUI）与勃起功能障碍（ED）的高风险相关。后尿道断裂修复类型对勃起功能的影响尚未明确。我们系统回顾并进行了一项荟萃分析，以研究（i）骨盆骨折合并PFUI后基线时、（ii）即刻一期复位后以及（iii）延迟尿道成形术后勃起功能障碍患者的比例。
使用一期复位或尿道成形术以及尿道断裂的检索词，我们系统回顾了PubMed和EMBASE。采用随机效应模型对勃起功能障碍患者的比例进行荟萃分析。
在检索到的734篇文章中，24篇符合纳入标准。（i）PFUI后勃起功能障碍患者比例（95%置信区间）估计为34（25 - 45）%，（ii）即刻一期复位后为16（8 - 26）%，（iii）延迟尿道成形术后比该队列中骨盆骨折后的34%又增加了3（2 - 5）%。
骨盆骨折后，34%的患者存在勃起功能障碍。一期内镜复位后，报告的勃起功能障碍发生率较低（16%）。延迟尿道成形术在仅与PFUI相关的34%基础上又增加了3%的风险，37%的患者出现新发勃起功能障碍。一期内镜复位与延迟尿道成形术后新发勃起功能障碍的差异可能是由于勃起功能障碍报告差异和/或损伤较轻的患者接受一期复位所致。
