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The Risk of Erectile Dysfunction Following Pelvic Angiographic Embolization in Pelvic Fracture Patients: A Nationwide Population-Based Cohort Study in Taiwan

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Abstract

Background

Pelvic fracture with hypovolemic shock is a known crucial injury in trauma patients. Pelvic fracture with vessel injury often leads to hemodynamic complications; in a trauma scenario, evidence of other systems being affected is often absent. Bleeding cessation and resuscitation are important for these types of trauma patients. For this purpose, pelvic angiographic embolization is frequently used. Multiple studies have reported that angiographic embolization may cause erectile dysfunction (ED) in hemodynamically stable patients with pelvic fracture. However, no study has evaluated a large patient cohort with a long-term follow-up. We hypothesized that angiographic embolization to control bleeding may compromise blood supply to the genitourinary organs or cause secondary neurogenic injury that increases the risk of ED. Our goal was to evaluate the risk of ED following pelvic fractures in male patients treated with pelvic angiographic embolization.

Methods

We used data from the National Health Insurance Research Database (NHIRD) from 1997 to 2010 provided by the Bureau of National Health Insurance of the Department of Health in Taiwan. We collected disease histories from inpatient files. The disease diagnoses were based on the International Classification of Diseases (ICD), Ninth Revision, Clinical Modification. These data were all deidentified, and we did not contact the patients. As such, informed consent was not needed.

Results

Eighty-five and 82,802 patients were included in the case and control cohorts, respectively. All patients were aged 15–45, and the proportion of pelvic fracture locations was equal between the groups. After investigating the causes of ED among male patients aged 15–45 with pelvic fractures using logistic regression analysis in a generalized estimating equations model and after adjusting for the influence of confounders, we found that these patients had high risks (odds ratio (OR): 32.637; 95% confidence interval: 14.137–75.346; P < 0.001) of developing ED post-angiographic embolization.

Conclusions

Male patients in Taiwan with pelvic fractures who undergo angiographic embolization to control bleeding have a higher risk of ED than those who do not undergo the procedure. Physicians should practice caution and inform patients of this connection before the procedure.

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Abbreviations

NHIRD:

National Health Insurance Research Database

ICD:

International Classification of Diseases

OR:

odds ratio

ED:

erectile dysfunction

NHI:

National Health Insurance

NHRI:

National Health Research Institutes

LHID:

Longitudinal Health Insurance Database

ICD-9-CM:

International Classification of Diseases, Ninth Revision, Clinical Modification

IIEF:

International Index of Erectile Function

NPT:

Nocturnal Penile Tumescence

GEE:

Generalized Estimating Equations

CIs:

confidence intervals

SAS:

Statistical Analysis System

ISS:

Injury Severity Score

REBOA:

Resuscitative Endovascular Balloon Occlusion of the Aorta

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Acknowledgements

The authors thank Editage (Cactus Communications Pvt., Ltd.), for their assistance with the English-language editing.

Funding

We thank all subjects who participated in the study. This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Division of Traumatic and General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

    Sheng-Der Hsu & Cheng-Jueng Chen

  2. Department of General Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

    I-Duo Wang

  3. Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

    Kuen-Tze Lin

  4. Department of Family Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

    Chia-Chi Wang

  5. Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

    Wu-Chien Chien & Chi-Hsiang Chung

  6. Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Chengong Rd, Sec. 2, Neihu, Taipei, 114, Taiwan

    Wei-Kuo Chang

Authors
  1. Sheng-Der Hsu
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  2. Cheng-Jueng Chen
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  3. I-Duo Wang
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  4. Kuen-Tze Lin
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  5. Chia-Chi Wang
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  6. Wu-Chien Chien
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  7. Chi-Hsiang Chung
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  8. Wei-Kuo Chang
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Contributions

WK Chang and SD Hsu were involved in conceptualization. WC Chien and CH Chung were involved in methodology. CJ Chen, KT Lin, SD Hsu, and WK Chang were involved in validation. ID Wang, CC Wang, and SD Hsu contributed to formal analysis. WK Chang and SD Hsu were involved in investigation. WC Chien and CH Chung were contributed to data curation. WK Chang and SD Hsu were involved in resources. SD Hsu was involved in writing—original draft. WK Chang and SD Hsu were involved in writing—review and editing. WK Chang was involved in supervision.

Corresponding author

Correspondence to Wei-Kuo Chang.

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Conflict of interests

All authors declare no conflict of interest.

Data availability statement

All data are fully available without restriction.

Ethical approval

The study methods were reviewed and approved by the Institutional Review Board II of the Tri-Service General Hospital, National Defense Medical Center.

Ethical standards

The disease diagnoses were based on the International Classification of Diseases, Ninth Revision, Clinical Modification. These data were all disconnected to these patients, and we did not really contact these patients. So informed consent of the study participants was not required and approved by the Institutional Review Board II of the Tri-Service General Hospital, National Defense Medical Center No 1-105-05-050.

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Hsu, SD., Chen, CJ., Wang, ID. et al. The Risk of Erectile Dysfunction Following Pelvic Angiographic Embolization in Pelvic Fracture Patients: A Nationwide Population-Based Cohort Study in Taiwan. World J Surg 43, 476–485 (2019). https://doi.org/10.1007/s00268-018-4803-7

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  • DOI: https://doi.org/10.1007/s00268-018-4803-7

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