The relationship between injury mechanism and sexual dysfunction in surgically treated pelvic fractures

Duramaz, Altuğ; İlter, Mehmet Hakan; Yıldız, Şükrü; Edipoğlu, Erdem; İpek, Cem; Bilgili, Mustafa Gökhan

doi:10.1007/s00068-018-01067-0

Cited by 9 publications

(14 citation statements)

References 21 publications

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“…Sixty studies were excluded because they did not fulfill inclusion criteria. Finally, 17 studies that met inclusion criteria were included in the review [5,10,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] (Figure 1). Among them, one had a level of evidence II, four had a level of evidence III, while 11 had a level of evidence IV [27].…”

Section: Study Selectionmentioning

confidence: 99%

Epidemiology and aetiology of male and female sexual dysfunctions related to pelvic ring injuries: a systematic review

Rovere

Perna

Meccariello³

et al. 2021

International Orthopaedics (SICOT)

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Introduction Pelvic ring injuries, frequently caused by high energy trauma, are associated with high rates of morbidity and mortality (5–33%), often due to significant blood loss and disruption of the lumbosacral plexus, genitourinary system, and gastrointestinal system. The aim of the present study is to perform a systematic literature review on male and female sexual dysfunctions related to traumatic lesions of the pelvic ring. Methods Scopus, Cochrane Library MEDLINE via PubMed, and Embase were searched using the keywords: “Pelvic fracture,” “Pelvic Ring Fracture,” “Pelvic Ring Trauma,” “Pelvic Ring injury,” “Sexual dysfunction,” “Erectile dysfunction,” “dyspareunia,” and their MeSH terms in any possible combination. The following questions were formulated according to the PICO (population (P), intervention (I), comparison (C), and outcome (O)) scheme: Do patients suffering from pelvic fracture (P) report worse clinical outcomes (C), in terms of sexual function (O), when urological injury occurs (I)? Is the sexual function (O) influenced by the type of fracture (I)? Results After screening 268 articles by title and abstract, 77 were considered eligible for the full-text analysis. Finally 17 studies that met inclusion criteria were included in the review. Overall, 1364 patients (902 males and 462 females, M/F ratio: 1.9) suffering from pelvic fractures were collected. Discussion Pelvic fractures represent challenging entities, often concomitant with systemic injuries and subsequent morbidity. Anatomical consideration, etiology, correlation between sexual dysfunction and genitourinary lesions, or pelvic fracture type were investigated. Conclusion There are evidences in the literature that the gravity and frequency of SD are related with the pelvic ring fracture type. In fact, patients with APC, VS (according Young-Burgess), or C (according Tile) fracture pattern reported higher incidence and gravity of SD. Only a week association could be found between GUI and incidence and gravity of SD, and relationship between surgical treatment and SD. Electrophysiological tests should be routinely used in patient suffering from SD after pelvic ring injuries.

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Section: Study Selectionmentioning

confidence: 99%

Epidemiology and aetiology of male and female sexual dysfunctions related to pelvic ring injuries: a systematic review

Rovere

Perna

Meccariello³

et al. 2021

International Orthopaedics (SICOT)

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“… 40 A recent publication concluded, similar to our observed results, that APC and VS fractures according to Young and Burgess are more associated with ED in men and sexual dysfunction in both sexes, than LC fractures. 41 In a review article from Harwood et al , 42 the rate of ED after pelvic fractures without PFUI ranges from 5% to 24% and from 9% to 72% with PFUI. They discussed the broad variance of assessment tools for ED as well as concomitant injuries as relevant reasons for the broad variability of the gathered data.…”

Section: Discussionmentioning

confidence: 99%

Erectile dysfunction and penile rehabilitation after pelvic fracture: a systematic review and meta-analysis

et al. 2021

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ObjectiveTo investigate the rate of erectile dysfunction (ED) after pelvic ring fracture (PRF).DesignSystematic review and meta-analysis.MethodsA systematic literature search of the Cochrane, EMBASE, MEDLINE, Scopus and Web of Science Library databases was conducted in January 2020. Included were original studies performed on humans assessing ED after PRF according to the 5-item International Index of Erectile Function (IIEF-5) questionnaire and fracture classification following Young and Burgess, Tile or Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association. Furthermore, interventional cohort studies assessing the effect of penile rehabilitation therapy with phosphodiesterase-5-inhibitors (PDE-5-I) on IIEF-5 scores compared before and after treatment were included. Results were presented as forest plots of proportions of patients with ED after PRF or mean changes on IIEF-5 questionnaires before and after penile rehabilitation. Studies not included in the quantitative analysis were narratively summarised. Risk of bias assessment was conducted using the revised tool for the Quality Assessment on Diagnostic Accuracy Studies.ResultsThe systematic literature search retrieved 617 articles. Seven articles were included in the qualitative analysis and the meta-analysis. Pooled proportions revealed 37% of patients with ED after suffering any form of PRF (result on probability scale pr=0.37, 95% CI: 0.26 to 0.50). Patients after 3 months of penile rehabilitation therapy reported a higher IIEF-5 score than before (change score=6.5 points, 95% CI: 2.54 to 10.46, p value=0.0013).ConclusionDespite some heterogeneity and limited high-quality research, this study concludes that patients suffering from any type of PRF have an increased risk of developing ED. Oral intake of PDE-5-I for the purpose of penile rehabilitation therapy increases IIEF-5 scores and may relevantly influence quality-of-life in these patients.PROSPERO registration numberCRD42020169699.

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“…12 Bladder rupture has been associated with a higher likelihood of FSD. 6,13,14 Furthermore, while a minority of female PFx is associated with GU injury, certainly vaginal lacerations, as well as urethral and bladder injuries, and subsequent repair are associated with subsequent development of FSD. 9,12,15,16 for example, Lee et al 15 (2015) reported a patient who presented with dyspareunia and impaired vaginal penetration owing to insufficient space in the vaginal orifice.…”

Section: Etiology Of Fsd After Pelvic Traumamentioning

confidence: 99%

“…Scar tissue and bladder rupture are also commonly associated with dyspareunia. 11,14 The percentage of female patients who report FSD across all accounts is significantly associated with the severity of the injury, as defined by the Short Form (SF)-36 scale, with 38% reporting decrease in sexual activity. 17 Similarly, sexual dysfunction is a more common complication in anteroposterior compression (APC) injuries.…”

Section: Etiology Of Fsd After Pelvic Traumamentioning

confidence: 99%

“…17 Similarly, sexual dysfunction is a more common complication in anteroposterior compression (APC) injuries. 10,11,14 Duramaz et al 14 used FSFI, Arizona Sexual Experiences Scale, and Majeed Pelvic Score to measure FSD and found that there was a statistically significant difference between fracture types. Results of mean FSFI, Arizona Sexual Experiences Scale, and Majeed Pelvic Score scores suggest that APC injury leads to increased sexual dysfunction as compared with vertical shear injuries and lateral compression fractures (Figure 2).…”

Section: Etiology Of Fsd After Pelvic Traumamentioning

confidence: 99%

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Female Sexual Dysfunction After Pelvic Fracture: A Comprehensive Review of the Literature

Walton

Leinwand

Raheem

et al. 2021

The Journal of Sexual Medicine

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Background Female sexual dysfunction (FSD) after pelvic fracture (PFx) has garnered little attention in the urology literature. Aim To review and summarize the current evidence regarding female PFx-related sexual function. Methods We performed a systematic review in accordance with PRISMA guidelines, including PubMed, EMBASE, and MEDLINE. We included only English-language manuscripts and abstracts with sufficient data for inclusion. We used the search terms “female sexual dysfunction AND pelvic fracture,” “sexual dysfunction AND pelvic fracture,” and “female pelvic fracture AND sexual dysfunction.” A total of 177 articles were identified; 41 abstracts were reviewed; of which, 19 manuscripts were reviewed. Fifteen met inclusion criteria for analysis. Outcomes The main outcome measures of this study are rates and types of female sexual dysfunction after pelvic fracture. RESULTS FSD is prevalent after PFx, with reported rates between 25% and 62%. Three studies used the validated Female Sexual Function Index. The other 12 used non-validated questionnaires or adapted quality-of-life questionnaires with specific questions regarding FSD. The most common complaints include difficulty with intercourse, dyspareunia, orgasmic dysfunction, genitourinary pain, decreased interest in intercourse, decreased satisfaction with intercourse, and pelvic floor dysfunction. Only 1 study addressed resolution of dysfunction (30 of 98 patients [30.4%]). Clinical Implications FSD is prevalent and an under-recognized sequela of pelvic fracture. This requires future prospective study to better characterize sexual dysfunction and identify effective treatments in trauma survivors. Strength and Limitations To Increase awareness of FSD after pelvic trauma and the impact on the quality of life in trauma survivors. The current literature is limited by a lack of standardized assessment of FSD, limited follow-up, and minimal discussion of treatment options, in addition to the inherent bias of retrospective studies. CONCLUSIONS FSD after traumatic PFx is not uncommon, occurs mostly in young women, and can be morbid. FSD after PFx is underreported in the urology literature. Thus, all female PFx patients should be screened for FSD by validated questionnaires. The published literature offers little knowledge as to the epidemiology, evaluation, definition, and potential treatments of FSD after PFx. Prospective studies are needed to better understand female sexual function in trauma survivors and the potential methods for prevention and rehabilitation, all within the context of a multidisciplinary approach.

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The relationship between injury mechanism and sexual dysfunction in surgically treated pelvic fractures

Cited by 9 publications

References 21 publications

Epidemiology and aetiology of male and female sexual dysfunctions related to pelvic ring injuries: a systematic review

Epidemiology and aetiology of male and female sexual dysfunctions related to pelvic ring injuries: a systematic review

Erectile dysfunction and penile rehabilitation after pelvic fracture: a systematic review and meta-analysis

Female Sexual Dysfunction After Pelvic Fracture: A Comprehensive Review of the Literature

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