Erectile Function in Patients With Pelvic Fracture Urethral Injury: What Are the Predictors of Persistent Severe Erectile Dysfunction After Delayed Anastomotic Urethroplasty?

To investigate factors associated with persistent erectile dysfunction (ED) after delayed anastomotic urethroplasty (DAU) in patients with pelvic fracture urethral injury (PFUI). This retrospective study included 57 sexually active male patients who underwent DAU between 2008 and 2023. Erectile function was assessed using the Sexual Health Inventory for Men (SHIM) questionnaire both preoperatively and at least 12 months postoperatively. Severe ED was defined as a postoperative SHIM score of 5-7. To identify predictors of severe ED, clinical data were analyzed from three key perspectives-patient-related parameters, trauma severity, and iatrogenic factors related to urethral reconstruction-using multivariate logistic regression. Postoperative satisfaction was evaluated using a 4-point Likert scale. Postoperatively, 30 patients (52.6%) were classified with severe ED. Older age (odds ratio [OR] 1.07 per year; 95% confidence interval [CI], 1.01-1.13; p = 0.01) and lower preoperative SHIM score (OR 1.15 per point; 95% CI, 1.01-1.30; p = 0.01) were independent predictors of severe ED. No trauma severity or iatrogenic factors were significantly associated with severe ED. The proportion of patients reporting being "very satisfied" with their DAU was significantly lower in the severe ED group (44.0%) than the non-severe ED group (75.0%, p = 0.03). Persistent severe ED after DAU is primarily associated with older age and poor baseline erectile function, while trauma severity and iatrogenic factors play a limited role. Patients with these risk factors should be counseled preoperatively regarding the likelihood of persistent ED.