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Complex strictures - Impotence

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Pelvic fracture injuries may lead to impotence. The incidence of impotence after SPC and delayed repair is around 20%. The impotence rate increases to 40% if a rail road technique is used during the first surgery. There are two reasons for impotence neurogenic and arteriogenic. Arteriogenic impotence is common. The neurogenic impotence would be because of two reasons. Neuropraxia i.e. temporary nerve injury may lead to temporary impotence which will recover in 9-12 months,  Neurotmesis injury lead to permanent impotence. The patients of neurogenic impotence respond well to intra cavernosal injections.

In those patients who have butterfly fractures of the pubic rami vasculogenic impotence may be the end result. These patients show inadequate blood flow through the cavernosal arteries after Papavarine injection. These patients may respond poorly to sildenafil and penile injections.

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