High Rates of Sexual and Urinary Dysfunction After Surgically Treated Displaced Pelvic Ring Injuries

Abstract

Background Pelvic ring injuries may be associated with genitourinary injury (GUI) and result in urinary or sexual dysfunction. Questions/purposes We determined (1) incidence of new sexual and urinary dysfunction after surgically treated pelvic ring injuries, (2) association of sexual or urinary dysfunction to fracture type and GUI, and (3) incidence and association between new sexual and urinary dysfunction in male and female patients without GUI. Methods We retrospectively studied 151 patients by postal questionnaire after pelvic reconstruction. Presence, type, and severity of new sexual dysfunction and urinary dysfunction were related to GUI and type of pelvic fracture using the Young and Burgess classification. Minimum followup was 1 year (median, 5 years; range, 1-12 years). Results New sexual dysfunction occurred in 61 of 143 (43%) and urinary dysfunction in 61 of 150 (41%) responding patients. Neither new sexual nor urinary dysfunction was associated with sex or GUI. In patients with no GUI, new sexual dysfunction was associated with chronologic age (odds ratio [OR], 1.04/year; 95% CI, 1.01-1.07) and pelvic fracture type. Lateral compression injury was less likely to result in new sexual or urinary dysfunction compared with AP type (sexual OR, 1.73; 95% CI, 0.67-4.47; urinary OR, 2.97; 95% CI, 1.15-7.66) and vertical shear type (sexual OR, 2.60; 95% CI, 1. urinary OR, 4.6; 95% CI,). Conclusions Our data suggest new sexual and urinary dysfunction occur at relatively high rates after pelvic fracture in patients with or without GUI. We recommend early assessment and referral for specialist treatment. Level of Evidence Level III, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Anatomic Relationship Between the Spermatic Cord and the Pubic Tubercle

“…Sexual dysfunction after injury to the pelvis has traditionally been attributed to vascular, neurogenic, psychological, and structural damage to the corpora cavernosum and pelvic floor, or a combination thereof. [7][8][9][10][11]30,31 The question of whether we as surgeons have contributed iatrogenic trauma such as suggested in our study does not seem to have been previously asked, let alone answered. To our knowledge, spermatic cord injury associated with clamp application has never been documented, nor has spermatic cord trauma been specifically described associated with pelvic ring injury.…”

“…[7][8][9][10][11]30,31 Patients with injuries causing diastasis of the pubic symphysis who underwent symphyseal plating seem to be particularly at risk. For example, Collinge et al 7 showed a 90% rate of erectile dysfunction in men after rotationally unstable "saddlehorn" injuries from horse riding treated with symphyseal plating.…”

Sexual Function Is Impaired After Common Orthopaedic Nonpelvic Trauma

“…1,10 Recent reviews of sexual dysfunction after pelvic fractures by Harvey-Kelly et al and Odutola et al discuss how sexual dysfunction after orthopaedic trauma can considerably decrease patient quality of life. [3][4][5] This was also shown by Borg et al in a 2010 study comparing pelvic fracture patients with favorable outcomes to uninjured patients. Outside the field of orthopaedics, the negative impact of sexual dysfunction on patient quality of life has been well described in urologic, gynecologic, and medical literature.…”

“…[1][2][3][4][5][6][7][8][9] It is an important issue to patients, as a survey by the American Association of Hip and Knee Surgeons indicated that up to 89% of patients desire information regarding sexual function after total hip arthroplasty. 1,10 Recent reviews of sexual dysfunction after pelvic fractures by Harvey-Kelly et al and Odutola et al discuss how sexual dysfunction after orthopaedic trauma can considerably decrease patient quality of life.…”

Sexual Activity at 1 Year after Acetabular Fracture

“…3) Studies on the problem related to sexual activity after pelvic ring injury, which is associated with injuries to the neighboring structures can cause sexual problems, 4,5) have been reported often. In the sphere of an acetabular fracture, one study investigated sexual activity which was evaluated as one of the many outcomes following acetabular fractures.…”