Harris Marek, Taylor Shay, McMillan Elijah, Zinabu Samrawit W, Wheaton Noah, Monroe Da'Jhai, Kim Sarah, Ocampo Emmanual, Ogbutor Kamdili, Michael Miriam B
Urology, Howard University College of Medicine, Washington, DC, USA.
Anesthesiology, Howard University Hospital, Washington, DC, USA.
Cureus. 2025 Jun 13;17(6):e85931. doi: 10.7759/cureus.85931. eCollection 2025 Jun.
Background Traumatic penile injuries (TPIs) pose significant medical and functional challenges, often requiring immediate surgical intervention. The type of anesthesia used during surgery may influence postoperative outcomes, including erectile dysfunction (ED). General anesthesia may impair vasodilation and tissue oxygenation, potentially increasing the risk of ED, while local anesthesia may better preserve neurovascular integrity. However, there is limited research evaluating the relationship between anesthesia type and long-term sexual function in patients with TPI. This retrospective cohort study investigates the impact of local vs. general anesthesia on ED incidence following TPI. Methods This retrospective cohort study utilized de-identified electronic health records (EHRs) from the TriNetX database, analyzing 20 years of data. Patients aged 6-24 years who underwent surgery for TPI were categorized into two cohorts: the local anesthesia cohort (n = 512) and the general anesthesia cohort (n = 512). Propensity score matching was used to balance baseline characteristics. The primary outcome was the incidence of ED within one year post-surgery. Statistical analyses included risk ratios (RR), odds ratios (OR), Kaplan-Meier survival estimates, and hazard ratios (HR). Results The incidence of ED was 4.7% in the local anesthesia group (24 patients) and 5.1% in the general anesthesia group (26 patients). Risk difference (-0.004, 95% CI: -0.030, 0.022) and RR (0.923, 95% CI: 0.537-1.586) suggested no significant association between anesthesia type and ED risk. Kaplan-Meier survival analysis showed 93.36% of local anesthesia patients and 92.49% of general anesthesia patients remained ED-free at one year (p = 0.750). The HR analysis (HR = 0.914, p = 0.435) further indicated no significant difference in the time to ED development. Conclusion This study found no statistically significant difference in the incidence, risk, or timing of ED between local and general anesthesia groups following TPI surgery. These findings suggest that anesthesia type does not independently influence long-term erectile function, providing flexibility in anesthetic selection based on patient and procedural factors. Future prospective studies are warranted to further investigate potential confounders and refine perioperative strategies to optimize sexual function outcomes in TPI patients.
背景 创伤性阴茎损伤（TPI）带来了重大的医学和功能挑战，通常需要立即进行手术干预。手术期间使用的麻醉类型可能会影响术后结果，包括勃起功能障碍（ED）。全身麻醉可能会损害血管舒张和组织氧合，潜在地增加ED的风险，而局部麻醉可能更好地保留神经血管完整性。然而，评估TPI患者麻醉类型与长期性功能之间关系的研究有限。这项回顾性队列研究调查了局部麻醉与全身麻醉对TPI后ED发生率的影响。方法 这项回顾性队列研究利用了TriNetX数据库中去识别化的电子健康记录（EHR），分析了20年的数据。接受TPI手术的6至24岁患者被分为两个队列：局部麻醉队列（n = 512）和全身麻醉队列（n = 512）。倾向评分匹配用于平衡基线特征。主要结局是术后一年内ED的发生率。统计分析包括风险比（RR）、比值比（OR）、Kaplan-Meier生存估计和风险比（HR）。结果 局部麻醉组ED的发生率为4.7%（24例患者），全身麻醉组为5.1%（26例患者）。风险差异（-0.004，95% CI：-0.030，0.022）和RR（0.923，95% CI：0.537 - 1.586）表明麻醉类型与ED风险之间无显著关联。Kaplan-Meier生存分析显示，一年时93.36%的局部麻醉患者和92.49%的全身麻醉患者仍无ED（p = 0.750）。HR分析（HR = 0.914，p = 0.435）进一步表明ED发生时间无显著差异。结论 本研究发现TPI手术后局部麻醉组和全身麻醉组在ED的发生率、风险或发生时间上无统计学显著差异。这些发现表明麻醉类型不会独立影响长期勃起功能，基于患者和手术因素在麻醉选择上提供了灵活性。未来有必要进行前瞻性研究，以进一步调查潜在的混杂因素并完善围手术期策略，以优化TPI患者的性功能结局。
