What are the risk factors for erectile dysfunction following penile fracture surgery? A systematic review and meta-analysis.

Background: Penile fracture is one of the rare urological emergencies resulting in rupture of the tunica albuginea in the penile corpora cavernosa. Sexual intercourse is known to be the most common aetiology of penile fracture, which usually happens during erection. Immediate surgical intervention is crucial to avoid any complications. Erectile dysfunction is the most feared complication after surgery. This meta-analysis aimed to analyse and determine risk factors of erectile dysfunction among patients who underwent penile fracture surgery.

Methods: Literature searching was conducted in several databases, e.g., Pubmed, Cochrane, ScienceDirect, Google Scholar and DOAJ by applying the Boolean term method. Statistical analyses and risk of bias assessment were calculated through RevMan 5.4.1 and the Newcastle Ottawa Scale (NOS), respectively. Outcomes were presented as odds ratio (OR).

Results: A total of 6 studies were included, encompassing 527 patients who were diagnosed with penile fracture and underwent surgery for repairment. Risk factors for post-surgery erectile dysfunction were calculated. Age (OR = 0.19, 95% CI [0.07, 0.52], p=0.001), location of fracture (OR = 0.43, 95% CI [0.22, 0.84], p=0.01), and side of fracture (OR = 0.06, 95% CI [0.02, 0.21], p<0.0001) have significant relations with erectile dysfunction. Whereas aetiology, urethral injury, and timing of presentation have statistically non significant effect on the incidence of erectile dysfunction.

Conclusions: This systematic review and meta-analysis showed that patients over 50 years of age, those with midshaft fracture, and those with bilateral fractures are significantly more likely to have erectile dysfunction following penile fracture surgery.