IMPOTENCE FOLLOWING PELVIC FRACTURE URETHRAL INJURY - INCIDENCE, ETIOLOGY AND MANAGEMENT

Objective To evaluate the potency status of patients undergoing delaye d perineal repair following a pelvic fracture urethral injury to deter mine the incidence and aetiology of impotence. Patients and methods Lo ng-term potency (>6 months post-operatively) was subjectively evaluate d in 92 patients and correlated with their pre-operative and intra-ope rative findings. The management of their impotence was also reviewed. Thirty original pelvic radiographs were assessed independently to dete rmine if the pattern of bony injury was associated with the developmen t of impotence. Results Fifty-seven patients (62%) remained impotent i n the long term with a median follow-up of 48 months (range 12-128) an d the operation did not render any potent patient impotent. Self-injec tion with vasoactive agents was successful in 24 of 27 (89%), suggesti ng a neurogenic aetiology in the majority. Bilateral pubic rami fractu re was also associated with a high incidence of impotence. Conclusion Disruption of the cavernosal nerves lateral to the prostatomembranous urethra behind the symphysis pubis is the most likely cause of impoten ce in this injury.