Erectile Dysfunction and Penile Rehabilitation after Pelvic Fracture – a Systematic Review and Meta-Analysis

Objective To investigate the rate of erectile dysfunction (ED) after
pelvic ring fracture (PRF). Design Systematic review, and meta-analysis.
Methods A 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 the 5-item International Index of Erectile Function (IIEF-5)
questionnaire and fracture classification following Young &
Burgess, Tile or AO/OTA (Arbeitsgemeinschaft für Osteosynthesefragen /
Orthopedic Trauma Association). Further, 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 summarized. Risk of
bias assessment was conducted using the revised tool for the Quality
Assessment on Diagnostic Accuracy studies (QUADAS-2). Results The
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 [CS] = 6.5 points, 95% CI: 2.54 to
10.46, p-value = 0.0013). Conclusion Despite 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 (QoL)
in these patients.