Mazzone Andrew, Anderson Ross, Voelzke Bryan B, Vanni Alex J, Elliott Sean P, Breyer Benjamin N, Erickson Bradley A, Buckley Jill, Myers Jeremy
University of Utah, Salt Lake City, UT, USA.
Urology Nevada, Reno, NV, USA.
Transl Androl Urol. 2021 May;10(5):2043-2050. doi: 10.21037/tau-20-1287.
To evaluate erectile and sexual function after pelvic fracture urethral injury (PFUI) by performing a retrospective review of a large multi-center database. We hypothesized that most men will have erectile dysfunction (ED) and poor sexual function following PFUI, which will remain after posterior urethroplasty.
Using the Trauma and Urologic Reconstructive Networks of Surgeons (TURNS) database, we identified PFUI patients undergoing posterior urethroplasty. We excluded patients with incomplete demographic, surgical and/or questionnaire data. Sexual Health Inventory of Men (SHIM), Male Sexual Health Questionnaire (MSHQ), and subjective changes in penile curvature were collected before urethroplasty surgery and at follow-up. We performed descriptive statistics for erectile and ejaculatory function using STATA v12.
We identified 92 men meeting inclusion criteria; median age was 41.7 years and BMI was 26.5. The mechanism of injury was blunt in all patients, and average distraction defect length was 2.3 cm (SD 1.0 cm). In the 38 patients who completed both pre and post-operative SHIM questionnaires, the mean SHIM score was 10.5 (SD 7.0), with 63% having severe ED (SHIM <12). The median follow-up was 5.6 months and the mean post-operative SHIM was 9.3 (SD 6.5), with 68% having severe ED. The mean change in SHIM score was -1.18 (SD 6.29) with 6 (16%) patients reporting ED (≥5 point decrease in score). Of the men with pre-operative MSHQ data, 46/74 (62.1%) had difficulty with ejaculation, 25/35 (71%) had change in penile length, and 6/33 (18%) reported penile curvature. In men with post-operative MSHQ, 19/44 (43%) expressed difficulty with ejaculation, 23/32 (72%) had change in penile length, and 9/33 (27%) reported penile curvature.
There is a high rate of severe ED, both following PFUI and remaining after posterior urethroplasty. Additionally, rates of ejaculatory difficulty and patient perceived changes in penile length and curvature underscore the complex nature of the impact of these injuries on sexual function beyond simple erectile function.
通过对一个大型多中心数据库进行回顾性分析，评估骨盆骨折后尿道损伤（PFUI）后的勃起功能和性功能。我们假设大多数男性在PFUI后会出现勃起功能障碍（ED）和性功能不佳，并且这些问题在后尿道成形术后仍会存在。
使用外科医生创伤与泌尿外科重建网络（TURNS）数据库，我们识别出接受后尿道成形术的PFUI患者。我们排除了人口统计学、手术和/或问卷数据不完整的患者。在尿道成形术前和随访时收集男性性健康量表（SHIM）、男性性健康问卷（MSHQ）以及阴茎弯曲度的主观变化情况。我们使用STATA v12对勃起和射精功能进行描述性统计。
我们确定了92名符合纳入标准的男性；中位年龄为41.7岁，体重指数为26.5。所有患者的损伤机制均为钝性损伤，平均牵张缺损长度为2.3厘米（标准差1.0厘米）。在38名完成术前和术后SHIM问卷的患者中，SHIM平均得分为10.5（标准差7.0），63%患有重度ED（SHIM<12）。中位随访时间为5.6个月，术后SHIM平均得分为9.3（标准差6.5），68%患有重度ED。SHIM评分的平均变化为-1.18（标准差6.29），6名（16%）患者报告有ED（评分下降≥5分）。在有术前MSHQ数据的男性中，46/74（62.1%）射精困难，25/35（71%）阴茎长度有变化，6/33（18%）报告有阴茎弯曲。在有术后MSHQ数据的男性中，19/44（43%）表示射精困难，23/32（72%）阴茎长度有变化，9/33（27%）报告有阴茎弯曲。
PFUI后以及后尿道成形术后重度ED的发生率都很高。此外，射精困难的发生率以及患者察觉到的阴茎长度和弯曲度的变化突出了这些损伤对性功能影响的复杂性，其影响不仅仅局限于单纯的勃起功能。
