骨盆骨折后尿道损伤患者器质性勃起功能障碍的临床特征分析

Clinical characteristics analysis of patients with organic erectile dysfunction after pelvic fracture urethral injury

目的探讨分析男性骨盆骨折后尿道损伤患者发生器质性阴茎勃起功能障碍的临床特征,并讨论其危险因素。方法本组纳入2013年12月至2018年6月入住上海市第六人民医院及徐汇分院泌尿外科因骨盆骨折后尿道损伤拟行初次尿道修复重建手术的22~50岁男性患者。分别采集受伤时骨盆骨折类型(Tile's/AO分类)、受伤时间,术中尿道狭窄或闭锁长度及部位,受伤前后主观性评分(IIEF-5评分)。术前常规先行夜间阴茎勃起功能检测(NPT,rigiscan系统)至少连续两夜,选取两夜中较好的一次作为结果,并进行药物性阴茎血流超声评估阴茎内勃起血管的功能。综合上述数据得出相关器质性ED的分类比例及严重程度,并使用统计学方法进行数据分析得出相关危险因素。结果本组纳入骨盆骨折后尿道狭窄(闭锁)患者56例(市六医院54例,徐汇分院2例)。患者年龄22~50岁,平均35.6岁。伤后时间3月至12月,平均7.9个月;本组患者受伤前均诉有正常性能力,受伤后IIEF-5评分明显下降(P<0.05)。根据NPT检测结果明确器质性ED组:40例(71.43%);非器质性ED组:16例,器质性ED组和非器质性ED组的尿道狭窄(闭锁)长度分别为(3.45±0.76)cm和(2.19±0.65)cm,差异具统计学意义(P<0.05);器质性ED组内,存在血管性ED的有32例(80%),其中动脉性7例,静脉性18例,动静脉混合性7例。组内分析显示,骨盆骨折损伤程度更高者其夜间总勃起次数,最佳勃起持续时间,阴茎头、基底部硬度和膨胀度、动脉血流收缩期峰速及阻力指数均有显著下降(P<0.05)。结论骨盆骨折后所致尿道损伤患者器质性ED发生率较高,勃起血管的损伤占很大比例。而该类患者器质性ED发生与外伤的严重程度有关,骨盆骨折类型、合并尿道损伤程度是主要决定的关键因素。

Objective To analyze the clinical features of organic erectile dysfunction in male patients with posterior urethral injury caused by pelvic fracture,and discuss the risk factors.Methods Between Dec 2013 and Jun 201&the male patients aged 22〜50 years with posterior urethral strictures after suffering from pelvic fracture were enrolled in our study,who planned to undergo primary urethral repair and reconstruction.Detailed medical history of patients was completed at admission,including types of pelvic fractures(Tile's/AO classification),time of injury,length and location of urethral stricture or atresia,and IIEF-5 score before and after injury.Nocturnal penile tumescence tests(NPT,Rigiscan assessment system,continuing two nights,the better outcome was selected as the result)and pharmaceutical penile duplex ultrasound(PPDU)with intracavemous injection were performed in each patient.The classification proportion and severity of organic ED were obtained by synthesizing the above data,and the related risk factors were obtained by statistical analysis.Results Forty-six eligible cases were enrolled in this study(54 cases from Shanghai sixth people's hospital and 2 cases from Shanghai eighth people's hospital).The patients ranged in age from 22 to 50 years,with an average age of 35.6 years.The interval time was 3〜12 months after the injury(average 7.9 months).All patients in this group complained of normal sexual ability before injury,but their IIEF-5 scores decreased significantly after injury(PV0.05).NPT test results confirmed 40 cases(71.43%)in the organic ED group and 16 cases in non-organic ED group.There was a statistical difference in the length of urethralstricture(atresia)between these two groups(3.45±0.76 vs 2.19±0.65cm,PV0.05).In the organic ED group,there were 32 cases(80%)of vascular ED,including 7 cases of arterial ED,18 cases of venous ED and 7 cases of mixed arteriovenous ED.In the intra-group analysis,those with higher degree of pelvic fracture injury had less number of erections;worse duration of the best event;worse base/tip tumescence and rigidity;worse peak systolic velocity and resistance index of the blood flow(P<0.05).Conclusion The incidence of organic ED is high in patients with posterior urethral injury caused by pelvic fracture.Pelvic fracture urethral injury was the main factor leading to organic ED,which would probably cause erectile vascular damage.The development of organic ED after PFUI in these patients can be influenced by the severity of trauma,especially type of pelvic fracture and the degree of urethral injury.