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Chapter 17 - Andrological Care of the Patient with Spinal Cord Injury

from Section 3 - Clinical Evaluation and Treatment of Male Infertility

Published online by Cambridge University Press:  06 December 2023

By
Christian Fuglesang S. Jensen ,
Jens Sønksen  and
Dana A. Ohl
Edited by
Douglas T. Carrell ,
Alexander W. Pastuszak  and
James M. Hotaling
Douglas T. Carrell
Affiliation:
Utah Center for Reproductive Medicine
Alexander W. Pastuszak
Affiliation:
University of Utah
James M. Hotaling
Affiliation:
Utah Center for Reproductive Medicine
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Summary

Men with spinal cord injury often suffer from erectile dysfunction, ejaculatory dysfunction, infertility, and hypogonadism. Restoration of sexual and reproductive functions is a top priority and efficient treatment modalities exist. Erectile dysfunction can be treated with phosphodiesterase-5 inhibitors and if unsuccessful intracavernosal injections can be tried. When injections fail a penile implant can ultimately be an option. Anejaculation and the resulting infertility are treated in a stepwise approach with penile vibratory stimulation, electroejaculation and surgical sperm retrieval followed by assisted reproduction. Assisted ejaculation is an effective and safe procedure but carries a risk of autonomic dysreflexia, especially in men with injuries at the level of T6 or above. Autonomic dysreflexia is an unregulated and uncontrolled response of the sympathetic nervous system but it can be safely managed. Hypogonadism is more prevalent in men with spinal cord injury compared to the general population and testosterone replacement therapy can be beneficial for alleviating symptoms of low testosterone, but testosterone-related spermatogenic suppression needs to be considered in men who wish to initiate a pregnancy.

Keywords

SCImen’s healtherectile dysfunctionhypogonadismlow Telectrostimulated ejaculationSCI reproductionsexual function
Type
Chapter
Information
Men's Reproductive and Sexual Health Throughout the Lifespan
An Integrated Approach to Fertility, Sexual Function, and Vitality
 , pp. 135 - 140
Publisher: Cambridge University Press
Print publication year: 2023

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References

Simpson, LA, et al. The health and life priorities of individuals with spinal cord injury: a systematic review. J Neurotrauma. 2012;29(8):1548–1555.Google Scholar
Biering-Sørensen, F, Sønksen, J. Penile erection in men with spinal cord or cauda equina lesions. Semin Neurol. 1992;12(2):98–105.CrossRefGoogle ScholarPubMed
Biering-Sørensen, F, Sønksen, J. Sexual function in spinal cord lesioned men. Spinal Cord. 2001;39(9):455–470.Google Scholar
Ohl, DA, et al. Efficacy and safety of sildenafil in men with sexual dysfunction and spinal cord injury. Sex Med Rev. 2017;5(4):521–528.Google Scholar
Sinha, V, et al. Reproductive health of men with spinal cord injury. Top Spinal Cord Inj Rehabil. 2017;23(1):31–41.Google Scholar
Chochina, L, et al. Intracavernous injections in spinal cord injured men with erectile dysfunction, a systematic review and meta-analysis. Sex Med Rev. 2016;4(3):257–269.CrossRefGoogle ScholarPubMed
Zermann, DH, et al. Penile prosthetic surgery in neurologically impaired patients: long-term followup. J Urol. 2006;175(3 Pt 1):1041–1044; discussion 1044.Google Scholar
Wieder, JA, et al. Anesthetic block of the dorsal penile nerve inhibits vibratory-induced ejaculation in men with spinal cord injuries. Urology. 2000;55(6):915–917.Google Scholar
Brackett, NL, et al. Treatment for ejaculatory dysfunction in men with spinal cord injury: an 18-year single center experience. J Urol. 2010;183(6):2304–2308.Google Scholar
Anderson, KD, et al. The impact of spinal cord injury on sexual function: concerns of the general population. Spinal Cord. 2007;45(5):328–337.Google Scholar
Kathiresan, AS, et al. Semen quality in ejaculates produced by masturbation in men with spinal cord injury. Spinal Cord. 2012;50(12):891–894.Google Scholar
Brindley, GS. Reflex ejaculation under vibratory stimulation in paraplegic men. Paraplegia. 1981;19(5):299–302.Google Scholar
Brackett, NL, et al. An analysis of 653 trials of penile vibratory stimulation in men with spinal cord injury. J Urol. 1998;159(6):1931–1934.Google Scholar
Castle, SM, et al. Safety and efficacy of a new device for inducing ejaculation in men with spinal cord injuries. Spinal Cord. 2014;52(Suppl. 2):S27–S29.Google Scholar
Sønksen, J, Biering-Sørensen, F, Kristensen, JK. Ejaculation induced by penile vibratory stimulation in men with spinal cord injuries: the importance of the vibratory amplitude. Paraplegia. 1994;32(10):651–660.Google Scholar
Bird, VG, et al. Reflexes and somatic responses as predictors of ejaculation by penile vibratory stimulation in men with spinal cord injury. Spinal Cord. 2001;39(10):514–519.Google Scholar
Krassioukov, A, et al. A systematic review of the management of autonomic dysreflexia after spinal cord injury. Arch Phys Med Rehabil. 2009;90(4):682–695.Google Scholar
Horne, HW, Paull, DP, Munro, D. Fertility studies in the human male with traumatic injuries of the spinal cord and cauda equina. N Engl J Med. 1948;239(25):959–961.Google Scholar
Halstead, LS, VerVoort, S, Seager, SW. Rectal probe electrostimulation in the treatment of anejaculatory spinal cord injured men. Paraplegia. 1987;25(2):120–129.Google Scholar
Denil, J, et al. Treatment of anejaculation with electroejaculation. Acta Urol Belg. 1992;60(3):15–25.Google Scholar
Heruti, RJ, et al. Treatment of male infertility due to spinal cord injury using rectal probe electroejaculation: the Israeli experience. Spinal Cord. 2001;39(3):168–175.CrossRefGoogle ScholarPubMed
McGuire, C, et al. Electroejaculatory stimulation for male infertility secondary to spinal cord injury: the Irish experience in National Rehabilitation Hospital. Urology. 2011;77(1):83–87.Google Scholar
Ohl, DA, et al. Electroejaculation and assisted reproductive technologies in the treatment of anejaculatory infertility. Fertil Steril. 2001;76(6):1249–1255.Google Scholar
Soeterik, TF, et al. Electroejaculation in patients with spinal cord injuries: a 21-year, single-center experience. Int J Urol. 2017;24(2):157–161.Google Scholar
Ibrahim, E, et al. Evaluation of a re-engineered device for penile vibratory stimulation in men with spinal cord injury. Spinal Cord. 2021;59(2):151–158.Google Scholar
Fode, M, Ohl, DA, Sønksen, J. A step-wise approach to sperm retrieval in men with neurogenic anejaculation. Nat Rev Urol. 2015;12(11):607–616.Google Scholar
Jensen, CF, et al. Multiple needle-pass percutaneous testicular sperm aspiration as first-line treatment in azoospermic men. Andrology. 2016;4(2):257–262.Google Scholar
Sønksen, J, et al. Vibratory ejaculation in 140 spinal cord injured men and home insemination of their partners. Spinal Cord. 2012;50(1):63–66.Google Scholar
Salonia, A, Carvalho, JP, Corona, G, et al. EAU Guidelines on Sexual and Reproductive Health. 2020. https://uroweb.org/guideline/sexual-and-reproductive-health/#3. Accessed November 1, 2022.Google Scholar
Barbonetti, A, et al. Correlates of low testosterone in men with chronic spinal cord injury. Andrology. 2014;2(5):721–728.Google Scholar
Behnaz, M, et al. Prevalence of androgen deficiency in chronic spinal cord injury patients suffering from erectile dysfunction. Spinal Cord. 2017;55(12):1061–1065.CrossRefGoogle ScholarPubMed
Sullivan, SD, et al. Prevalence and etiology of hypogonadism in young men with chronic spinal cord injury: a cross-sectional analysis from two university-based rehabilitation centers. PM R. 2017;9(8):751–760.Google Scholar
Lim, CAR, et al. Lifestyle modifications and pharmacological approaches to improve sexual function and satisfaction in men with spinal cord injury: a narrative review. Spinal Cord. 2020;58(4):391–401.Google Scholar
Bauman, WA, et al. Lean tissue mass and energy expenditure are retained in hypogonadal men with spinal cord injury after discontinuation of testosterone replacement therapy. J Spinal Cord Med. 2015;38(1):38–47.Google Scholar

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