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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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.
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.
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.
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.
List of abbreviations
National Health Insurance Research Database
International Classification of Diseases
National Health Insurance
National Health Research Institutes
Longitudinal Health Insurance Database
International Classification of Diseases, Ninth Revision, Clinical Modification
International Index of Erectile Function
Nocturnal Penile Tumescence
Generalized Estimating Equations
Statistical Analysis System
Injury Severity Score
Resuscitative Endovascular Balloon Occlusion of the Aorta
The authors thank Editage (Cactus Communications Pvt., Ltd.), for their assistance with the English-language editing.
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.
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.
Compliance with ethical standards
Conflict of interests
All authors declare no conflict of interest.
Data availability statement
All data are fully available without restriction.
The study methods were reviewed and approved by the Institutional Review Board II of the Tri-Service General Hospital, National Defense Medical Center.
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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