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After pelvic fracture urethral injury on sexual function_4260

By Joanne Payne,2014-10-30 08:31
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After pelvic fracture urethral injury on sexual function_4260

After pelvic fracture urethral injury on sexual function

     Keywords pelvic fracture urethral injury after sexual function

     Impotence is a pelvic fracture and posterior urethral injuries after one of the complications. The reported incidence of 2.5% ~ 5.0%. Authors from

    March 1990 to October 2007, after pelvic fracture treated 68 patients with urethral injury, of which 36 cases of long-term follow-up occurred 14

    cases of impotence, now report on the results as follows.

     A clinical data

     The group of 36 patients, aged from 12 to 62 years, an average of 34 years old, both photo pelvis plain film, including butterfly fracture in 16 cases, 8 cases of pairs of straight fracture, simple fracture of the pubic bone in 5 cases, pubic symphysis separation of four cases, other

    types of fracture in 3 cases. 26 cases of complete posterior urethral rupture, in part fracture in 10 cases. Emergency urethral realignment increases traction in 23 cases, line cystostomy, ? period of urethral

    scar resection, end to end anastomosis in 10 cases, the urethra into the plus traction sets in 1 case, simple indwelling catheterization in 2 cases. 16 cases of urethral stricture after the formation of the above-

    mentioned treatment, just regular urethral dilation in 9 cases,

    transurethral incision scar in 5 cases, open surgery in 2 cases.

     2 follow-up results

     Patients are given a long-term follow-up, an average of 8.2 years. 5

    cases of minor injury when the (12 ~ 16 years), follow up found no erectile dysfunction, of whom 30 cases of sexual function were normal pre-

    injury after injury occurred after the initial 15 cases of impotence treatment (including 2 cases of traumatic sexual function recovery after two years normal), 1 case was the initial deal with sexual functioning

    properly due to urethral stricture occurred after open surgery erectile

dysfunction, impotence occurred in 14 cases, accounting for 38%.

     3 Discussion

     Pelvic fracture urethral injuries after the merger occurred after the

    impotence, mainly because the initial injury and (or) surgical penile erection caused by nerve damage, arterial injury caused by, and the pelvic fracture type, degree of tissue injury, surgical approach, the time extension and age, social and psychological factors.

     Walsh and so dominated by male penis autopsy found that pelvic nerve branches to walk in the prostate capsule and membranous urethra dorsal side, and with the supply of blood vessels accompanied by lines the urethra to form a neurovascular bundle. When the pelvic fractures of these delicate nerves and blood vessels can easily cause injury impotence [1]. The incidence of impotence and pelvic fracture type and degree of tissue injury are closely related to [2]. Butterfly fracture posterior urethral

    injuries often part of the distal urogenital diaphragm, and to shrink after the urogenital diaphragm. Such fractures, fracture line more severe tissue damage, amount of bleeding more easily so that walking in the Alcock's canal pudendal artery, pudendal nerve injury caused impotence.

    Such fractures in 16 cases in this group occurred 10 cases of impotence, the incidence of 63%. Pairs of straight parts after the fracture urethral injuries often occur in the proximal urogenital diaphragm, tissue damage

    heavy, large amount of bleeding. Such fracture injury in this paragraph is not only within the pudendal artery and walking in the soft tissue of the penis nerve, and the recovery process by urine extravasation, fibrosis, hematoma, infection and other factors affecting the more easily affect the

    penile erection nerves lead to impotence. 8 cases of such fractures in this group occurred 3 cases of impotence, the incidence of 38%. Simple separation of pubic symphysis pubic bone fractures and soft tissue injury

    of the small, small amount of bleeding occurred less impotence. This Type II fractures in this group 9 cases, only 1 case of impotence, the incidence of 11%. Reposted elsewhere in the paper for free download http://

     The incidence of impotence related to the way and surgical treatment.

    Chen Ling-Wu [3] through the pelvic plexus nerve anatomy erectile nerves found in the membranous urethra lateral and posterior lateral, distributed in urethral striated muscle in the side. Catheterization after urethral

    injury trial, emergency urethral realignment added traction, the latter part of urethral scar excision, end to end anastomosis of the urethra or both sets of income increases traction may damage the prostatic urethra membranous lateral and posterior lateral nerves lead to iatrogenic

    impotence. Catheterization alone in this group 2 cases, no impotence occurred; acute urethral realignment plus traction in 23 cases, impotence occurred in 5 cases, the incidence of 22%; the latter part of the urethra scar excision, end to end anastomosis in 10 cases, impotence occurred in 4 cases, occurred rate 40%; the urethra into the plus traction units 1 case

    occurred impotence. In order to reduce the incidence of impotence, the author believes that the pilot catheterization to be careful to avoid

    multiple, repeated tests, so as not to increase the urinary tract caused by peripheral nerve injury impotence. Urethral realignment increases traction, should try to avoid excessive separation of the prostate anatomy, especially the prostate on both sides of the edge of stump try to move closer, traction should be appropriate to avoid excessive nerve traction or stump separation caused by urine extravasation, bleeding, inflammation and secondary fibrosis Erzhi impotence erectile nerves.

    Perineal resection of the narrow lines, set into the urethral anastomosis, or surgery, should not be excessive membrane urethra lateral, posterior lateral striated muscle within the urogenital diaphragm, or may damage the membranous urethra, prostate apex posterior lateral penile erection nerves lead to iatrogenic impotence.

     After pelvic fracture urethral injury caused by impotence and follow-

    up time-related. Gibson reported after pelvic fracture urethral injury in 26 cases, 11 cases occurred impotence, 19 months 6 cases of functional

    recovery. 2 cases in this group were followed up for two years, returning to normal sexual function, suggesting that over time, some of impotence it possible to restore sexual function in patients, which may be related to

    the establishment of the collateral circulation.

     Erectile dysfunction with age, psychological factors. Many scholars believe that the positive correlation between erectile dysfunction with age may be a good collateral circulation with children, to trauma, surgery

    forgotten, without the mental burden. This group of five cases of minor injury patients with no impotence occurs also confirmed this point. Adult patients due to trauma, surgery and cost and other factors, the mental burden caused by heavy spiritual impotence may be related to psychological factors affect the central nervous system neurotransmitter release, activating sympathetic or to a combination of endocrine changes affect the erectile function.

     References

     A Li Chi. Urethral injury and impotence. Clinical Journal of Urology, 1992,7 (4): 231.

     2 Chen Chi-ling. Urethral injuries after pelvic fracture mechanism and injury severity estimates. China Urology, 1990,11 (5): 298.

3, Chen Ling-Wu. Male pelvis anatomical landmark significance of the next

urinary tract surgery. Clinical Journal of Urology, 1996,11 (5): 272.

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