Comparative Analysis of Local Versus General Anesthesia and Its Impact on Erectile Dysfunction Risk Following Penile Surgery

Background Traumatic penile injuries (TPIs) pose significant medical and functional challenges, often requiring immediate surgical intervention. The type of anesthesia used during surgery may influence postoperative outcomes, including erectile dysfunction (ED). General anesthesia may impair vasodilation and tissue oxygenation, potentially increasing the risk of ED, while local anesthesia may better preserve neurovascular integrity. However, there is limited research evaluating the relationship between anesthesia type and long-term sexual function in patients with TPI. This retrospective cohort study investigates the impact of local vs. general anesthesia on ED incidence following TPI. Methods This retrospective cohort study utilized de-identified electronic health records (EHRs) from the TriNetX database, analyzing 20 years of data. Patients aged 6-24 years who underwent surgery for TPI were categorized into two cohorts: the local anesthesia cohort (n = 512) and the general anesthesia cohort (n = 512). Propensity score matching was used to balance baseline characteristics. The primary outcome was the incidence of ED within one year post-surgery. Statistical analyses included risk ratios (RR), odds ratios (OR), Kaplan-Meier survival estimates, and hazard ratios (HR). Results The incidence of ED was 4.7% in the local anesthesia group (24 patients) and 5.1% in the general anesthesia group (26 patients). Risk difference (-0.004, 95% CI: -0.030, 0.022) and RR (0.923, 95% CI: 0.537-1.586) suggested no significant association between anesthesia type and ED risk. Kaplan-Meier survival analysis showed 93.36% of local anesthesia patients and 92.49% of general anesthesia patients remained ED-free at one year (p = 0.750). The HR analysis (HR = 0.914, p = 0.435) further indicated no significant difference in the time to ED development. Conclusion This study found no statistically significant difference in the incidence, risk, or timing of ED between local and general anesthesia groups following TPI surgery. These findings suggest that anesthesia type does not independently influence long-term erectile function, providing flexibility in anesthetic selection based on patient and procedural factors. Future prospective studies are warranted to further investigate potential confounders and refine perioperative strategies to optimize sexual function outcomes in TPI patients.