Assessing the impact of urethroplasty on erectile function in patients with pelvic fracture urethral injuries: A comparative analysis of pre- and post-operative outcomes.

Objective: To evaluate the mean change in erectile function before and after urethroplasty in patients with Pelvic Fracture Urethral Injuries (PFUIs) and to identify predictors of post-operative erectile dysfunction. Study Design: Retrospective Cohort study. Setting: Department of Urology at A Tertiary Care Hospital Bilawal Medical College for Boys, Liaquat University of Medical & Health Sciences, Jamshoro. Period: January 2015 to December 2020. Methods: A total of 100 male patients (≥18 years) who underwent urethroplasty for PFUIs were included. Erectile function was assessed using the International Index of Erectile Function (IIEF-5) at baseline (pre-operative) and at 3, 6, and 12 months post-operatively. Data on demographics, injury severity, type of urethroplasty, and pre-operative erectile dysfunction were collected. Paired t-tests compared pre- and post-operative erectile scores. Multivariate regression identified predictors of changes in erectile function. Statistical analysis was performed using SPSS, with p < 0.05 considered significant. Results: The mean pre-operative erectile function score was 22.4 ± 4.2. Post-operatively, scores decreased to 19.8 ± 4.8 at 3 months, 20.5 ± 4.6 at 6 months, and 21.0 ± 4.5 at 12 months. Mean changes were statistically significant at all follow-ups (p < 0.05), indicating a temporary decline with gradual recovery. Severe PFUIs (p = 0.004) and pre-operative erectile dysfunction (p = 0.001) were significant predictors of greater declines. Complications included stricture recurrence (15%), post-operative infection (10%), dilation (12%), and repeat urethroplasty (8%). Conclusion: Urethroplasty for PFUIs results in a temporary decline in erectile function with partial recovery over one year. Patients with severe injuries or pre-existing erectile dysfunction are at greater risk for persistent post-operative dysfunction. Pre-operative counseling and tailored post-operative care are essential to address sexual health concerns and optimize long-term outcomes.