Erectile Dysfunction Secondary to Pudendal Nerve Injury Complicating Orthopedic Surgery: Practical Recommandations

Abstract

Erectile dysfunction (ED) resulting from direct damage of pudendal nerve injury during orthopedic surgery is common and closely associated to the use of traction tables. Prolonged countertraction on the fracture table and the inappropriate placement of the perineal post are the two main contributing factors. Clinical signs are essentially sensitive, such as hypoesthesia of the perineum. Urinary incontinence, ED and hypoesthesia or complete anesthesia of scrotum and glans penis are the main clinical manifestations. Electrophysiological examinations should be considered when symptoms are not regressive and in cases of vesico-sphincter dysfunction and immediate severe ED. No medical treatment has demonstrated its effectiveness. Pudendal nerve decompression was reported to be useful in some cases. Preventive measures should be considered by surgeons to avoid perineal traction injuries. Patients must be clearly informed about this possible neurological complication before an operation on the orthopedic table.

Relation between pelvic floor neurophysiological abnormalities and erectile dysfunction in patients with obstructed defecation

“…The percentage of patients with bilateral pudendal neuropathy was significantly higher among OD patients with ED. Pudendal neuropathy results in neurological changes in all pudendal nerve supplied muscles including EAS, IC and BC muscles [13,14,16,17]. This explained the statistically significant difference between patients with ED versus those without ED regarding the percentage of patients with evidence of neuropathic abnormalities in the form of denervation and chronic reinnervation in the EAS and BC muscles.…”

“…These data were not previously assessed in the literature. In the situation that pudendal neuropathy led to ED, this could be considered a form of neurogenic impotence [16,17,40].…”

“…These neurological changes could have a role in the impairment of the sexual functions among male patients with OD [15,16]. ED could be as a result of neurological abnormalities in the pelvic floor nerves and muscles [7,9,12,17].…”