Department of Urological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Urological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Sex Med Rev. 2018 Jan;6(1):114-123. doi: 10.1016/j.sxmr.2017.06.004. Epub 2017 Jul 27.
Although pelvic fracture urethral injuries (PFUIs) are rare, approximately half these patients will report erectile dysfunction (ED) after their injuries. The anatomic relations of the cavernosal nerves and arteries to the bones of the pelvis and the urethra put these structures at significant risk at the time of PFUI. This review examines the epidemiology, evaluation, and management of ED in this patient population.
To evaluate the epidemiology, pathophysiology, diagnosis, and management of patients with ED after PFUI.
A literature review was performed to identify articles on PubMed published before May 2017 addressing PFUI and ED.
Incidence, mechanisms, risk factors, evaluation, and management strategies of ED after PFUI were analyzed.
Patients with pelvic fractures are at risk of post-injury ED, whereas those with PFUI appear to be at even higher risk. Different potential mechanisms contributing to the pathophysiology of ED in this setting have been described in the literature, including damage to the nervous supply to the penis, arterial insufficiency, and veno-occlusive dysfunction. However, there is a lack of consensus on the predominant etiology. Appropriate diagnostic evaluation can help to elucidate the underlying pathophysiology on an individual basis and can help guide management. Oral therapies, intracavernosal injections, and inflatable penile prostheses have shown great success. Furthermore, unlike patients with ED from other causes, select patients with isolated arteriogenic ED are potentially eligible for penile revascularization procedures.
Because most patients with pelvic trauma are younger than 40 years with a significant life expectancy, appropriate diagnosis and management of ED after PFUI can greatly improve quality of life and allow resumption of post-injury sexual function. Identification of the causative pathology can help tailor treatment on an individual basis. Johnsen NV, Kaufman MR, Dmochowski RR, Milam DF. Erectile Dysfunction Following Pelvic Fracture Urethral Injury. Sex Med Rev 2018;6;114-123.
尽管骨盆骨折后尿道损伤（PFUI）较为罕见，但其中约有一半患者在受伤后会出现勃起功能障碍（ED）。海绵体神经和动脉与骨盆和尿道的骨骼解剖关系使这些结构在发生 PFUI 时面临很大的风险。本综述探讨了该患者群体中 ED 的流行病学、评估和管理。
评估 PFUI 后 ED 患者的流行病学、病理生理学、诊断和治疗。
对 2017 年 5 月前在 PubMed 上发表的关于 PFUI 和 ED 的文章进行了文献回顾。
分析了 PFUI 后 ED 的发病率、发病机制、危险因素、评估和管理策略。
骨盆骨折患者有发生损伤后 ED 的风险，而 PFUI 患者的风险似乎更高。文献中描述了不同的潜在机制可能导致该环境下 ED 的病理生理学，包括阴茎神经供应损伤、动脉功能不全和静脉阻塞性功能障碍。然而，对于主要病因尚缺乏共识。适当的诊断评估有助于根据个体情况阐明潜在的病理生理学，并有助于指导治疗。口服药物治疗、阴茎海绵体内注射和可膨胀性阴茎假体已取得巨大成功。此外，与其他原因引起的 ED 患者不同，选择具有孤立性动脉性 ED 的患者可能有资格进行阴茎血运重建手术。
由于大多数骨盆创伤患者的年龄均小于 40 岁，且预期寿命较长，因此 PFUI 后 ED 的适当诊断和治疗可以大大提高生活质量并恢复损伤后的性功能。确定致病病理学有助于根据个体情况定制治疗方案。
