Erectile dysfunction severity and penile Doppler findings in pelvic fracture urethral injury: A descriptive cohort study

ABSTRACT Introduction: Erectile dysfunction (ED) is a common and multifactorial complication after pelvic fracture urethral injury (PFUI), yet objective characterization of ED severity and penile Doppler findings remains limited. We aimed to describe ED severity categories and penile Doppler findings in men with PFUI undergoing anastomotic urethroplasty. Methods: We performed a retrospective analysis of a prospectively maintained database. Among 110 men who underwent anastomotic urethroplasty for PFUI between September 2022 and September 2023, 97 with complete preoperative penile Doppler ultrasound and standardized Sexual Health Inventory for Men assessment were included. Pelvic fractures were classified using the Young–Burgess system. All patients received tadalafil 5 mg daily for 6 months. Postoperative Doppler was not performed. Results: The median age was 29.5 years with a median follow-up of 11 months. Urethroplasty success rate was 85%(83/97). Preoperatively, 56 out of 97 patients had ED (42 mild/moderate; 14 severe). Penile Doppler abnormalities were nearly universal: 93 had cavernosal, and 83 had dorsal artery insufficiency. Postoperatively, 13 out of 41 men developed de novo ED, while 13 out of 56 improved by at least one severity category. Among 76 patients with complete fracture data, greater fracture severity was associated with worse postoperative ED, and worsening erectile function was more frequent among patients with urethroplasty failure. Conclusions: ED and penile Doppler abnormalities are highly prevalent after PFUI. ED severity correlated with pelvic injury severity, supporting the concept that ED reflects global trauma burden rather than isolated vascular pathology. Given the retrospective design and routine postoperative use of PDE5 inhibitors, these findings should be considered descriptive and hypothesis-generating.