Erectile dysfunction following end-to-end urethroplasty in pelvic fracture urethral distraction defect patients

Objectives: The close relationship of the neuro-vascular bundle, cavernosal tissue of the penis and the bony pelvis results in high risk of concomitant injury associated with pelvis fractures, with resultant urethral defect and erectile dysfunction (ED). The present study aims to analyse and correlate the type of trauma, number of surgical interventions, urethral defect length and surgical steps performed during urethroplasty with erectile function. Method: This was an observational study. All patients with pelvis fracture urethral distraction defect (PFUDD) who required end-to-end urethroplasty (E-E urethroplasty) from August 2010 to July 2014 were included. Results: Thirty-four per cent had defect length of 0.5–2 cm, 50% had defect length of 2.1–4 cm. Of 32, 34% required re-intervention. Inferior pubectomy was required in 36% in the 0.5–2 cm group and in 94% in the 2.1–4 cm group. On follow-up, 22% of patients had neurogenic ED, and 63% had vascular ED, of whom 44% had arterial, 3% had venous, and 16% had mixed aetiology. Patients with neurogenic aetiology had shorter urethral defect and 43% needed inferior pubectomy. Patients with vascular aetiology had longer urethral defect, 90% required inferior pubectomy. Conclusions: ED is related to the length of urethral defect, and operative manoeuvers performed during E-E urethroplasty.