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Specific fracture configurations predict sexual and excretory dysfunction in men and women 1 year after pelvic fracture.

Wright JL, Nathens AB, Rivara FP, MacKenzie EJ, Wessells H

Department of Urology, Surgery, Pediatrics and Epidemiology, University of Washington School of Medicine, Harborview Medical Center and Harborview Injury Prevention Research Center, Seattle, Washington 98104, USA.

PURPOSE: We determined the prevalence and predictors of sexual and excretory dysfunction in patients 1 year after pelvic fracture. MATERIALS AND METHODS: The multicenter Pennsylvania Trauma Outcomes Study enrolled 1,238 patients and contacted them 1 year after injury. Sexual limitations and excretory dysfunction (bladder/bowel incontinence) were defined based on responses from the Functional Capacity Index. Health related quality of life was determined using SF-36. The relationship between specific fracture patterns and dysfunction along with the effect of dysfunction on quality of life in patients with pelvic fracture were evaluated by multivariate analysis. RESULTS: Of 1,160 eligible patients 292 (26%) had pelvic fractures. Sexual dysfunction was reported in 21% vs 14% of those with vs without pelvic fractures and bowel or bladder incontinence was reported in 8% vs 4%. On multivariate analysis men with sacroiliac fractures were at higher risk for sexual (RR 4.0, 95% CI 2.3 to 6.8) and excretory (RR 4.3, 95% CI 1.4 to 13.5) dysfunction. In women symphyseal diastasis was associated with sexual (RR 4.8, 95% CI 2.0 to 11.2) and excretory (RR 12.5, 95% CI 1.9 to 80.2) dysfunction. Of patients with pelvic fractures men with sexual dysfunction and women with excretory dysfunction had significantly worse quality of life than those without dysfunction. CONCLUSIONS: One year after trauma men with sacroiliac fractures and women with symphyseal diastasis were at increased risk for sexual and excretory dysfunction independent of overt pelvic organ injury. In patients with pelvic fracture male sexual dysfunction and female excretory dysfunction were associated with decreased quality of life. Our data highlight the need for further study of dysfunction following pelvic trauma and interventions to decrease the risk of long-term disability.

Published 5 September 2006 in J Urol, 176(4): 1540-5; discussion 1545.
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