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.