Penile Vibratory Stimulation in Patients with Spinal Cord Injury

Česká verzia

Authors: M. Čechová ¹; J. Kříž ²; P. Paulasová ³; J. Černíková ³; M. Chocholatý ¹
Authors place of work: Urologická klinika 2. LF UK a FN v Motole, Praha ¹; Spinální jednotka při Klinice RHB a TVL 2. LF UK a FN v Motole, Praha ²; Ústav biologie a lékařské genetiky, 2. LF UK a FN v Motole, Praha ³
Published in the journal: Cesk Slov Neurol N 2015; 78/111(2): 200-204
Category: Short Communication

Summary

Objectives:
Following spinal cord injury (SCI), ejaculatory dysfunctions are frequent. In men who wish to father children, assisted sperm retrieval is often necessary. Penile vibratory stimulation (PVS) is a non-invasive method for sperm retrieval in patients with a lesion above T10. The aim of our research was to evaluate the effectiveness and safety of PVS, semen quality and further utilization of the ejaculate.

Methods:
Between 2010 and 2014, we performed PVS in 20 patients. An injury of the cervical (C) and thoracic (T) spinal cord was present in 13 and seven patients, respectively. The mean age of patients was 30.8 years. The mean time from the injury to PVS was 64 months. Seven patients had the first PVS more than 3.5 years after the injury and 13 patients less than 3.5 years. FERTI CARE Multicept was used for PVS.

Results:
Ejaculation was achieved in 11 patients (55%) – in nine with C and in two with T SCI. Success rate of PVS in patients less than 3.5 years after the injury was 77%, compared to 14% in patients more than 3.5 years after the injury, p = 0.027. Total sperm count (p = 0.03), sperm concentration (p = 0.025) and the number of sperm with progressive motility (p = 0.027) increased in the semen from the second PVS. Obtained ejaculate is mostly (72%) cryopreserved only for further use. The ejaculate was used for fertilisation in two patients. One patient had azoospermia. Autonomic dysreflexia during PVS occurred in seven patients, symptoms resolved within 3 mins.

Conclusion:
PVS is a safe method for sperm retrieval. Semen quality improved with repeated PVS. The ejaculate was successfully used for fertilisation in two patients.

Key words:
penile vibratory stimulation – spinal cord injury – anejaculation

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Zdroje

1. Fitzharris M, Cripps RA, Lee BB. Estimating the global incidence of traumatic spinal cord injury. Spinal Cord 2014; 52(2): 117– 122. doi: 10.1038/ sc.2013.135.

2. New PW, Cripps RA, Bonne Lee BB. Global maps of non‑traumatic spinal cord injury epidemiology: towards a living data repositury. Spinal Cord 2014; 52(2): 97– 109. doi: 10.1038/ sc.2012.165.

3. Česká společnost pro míšní léze ČSL JEP, statistiky [online]. Dostupné z URL: http:/ / www.spinalcord.cz/ cz/ statistiky.

4. Chéhensse C, Bahrami S, Denys P, Clément P, Barnabé J,Giuliano F. The spinal control of ejaculation revisited: A systematic review and meta‑analysis of anejaculation in spinal cord injured patients. Human Reproduction Update 2013; 19(5): 507– 526. doi: 10.1093/ humupd/ dmt029.

5. Brackett NL, Lynne CM, Ibrahim E, Ohl DA, Sønksen J. Treatment of infertility in men with spinal cord injury. Nat Rev Urol 2010; 7(3): 162– 172. doi: 10.1038/ nrurol.2010.7.

6. Giuliano F. Neurophysiology of erection and ejaculation. J Sex Med 2011; 8 (Suppl 4): 310– 315. doi: 10.1111/ j.1743‑ 6109.2011.02450.x.

7. Brindley GS. Reflex ejaculation under vibratory stimulation in paraplegic men. Paraplegia 1981; 19(5): 299– 302.

8. Giuliano F, Clément P. Physiology of ejaculation: emphasis on serotonergic control. Eur Urol 2005; 48(3): 408– 417.

9. Wieder JA, Brackett NL, Lynne CM, Green JT, Aballa TC. Anestetic block of the dorsal penile nerve inhibits vibratory‑induced ejaculation in men with spinal cord injuries. Urology 2000; 55(6): 915– 917.

10. Anderson KD, Borisoff JF, Johnson RD, Stiensen SA, Elliott SL. Long‑term effects of spinal cord injury on sexual function in men: implications for neuroplasticity. Spinal cord 2007; 45(3): 338– 348.

11. Brackett NL, Padron O F, Lynne CM. Semen quality of spinal cord injured men is better when obtained by vibratory stimulation versus electroejaculation. J Urol 1997; 157(1): 151– 157.

12. Ohl DA, Quallich SA, Sønksen J, Brackett NL, Lynne CM. Anejaculation and retrograde ejaculation. Urol Clin North Am 2008; 35(2): 211– 220. doi: 10.1016/ j.ucl.2008.01.014.

13. Beckerman H, Becher J, Lankhorst GJ. The effectiveness of vibratory stimulation in anejaculatory men with spinal cord injury. Review article. Paraplegia 1993; 31(11): 689– 699.

14. Bird VG, Brackett NL, Lynne CM, Aballa TC, Ferrell SM. Reflexes and static responses as predictors of ejaculation by penile vibratory stimulation in men with spinal cord injury. Spinal Cord 2001; 39(10): 514– 519.

15. Brackett NL, Ferrell SM, Aballa TC, Amador MJ, Pad-ron OF, Sonksen J et al. An analysis of 653 trials of penile vibratory stimulation in men with spinal cord injury. J Urol 1998; 159(6): 1931– 1934.

16. Sipski ML, Brackett NL, Bodner D, Elliott S, Jackson A, Sonksen J. Measurement of sexual functioning after spinal cord injury: preferred instruments. J Spinal Cord Med 2009; 32(3): 226– 236.

17. Courtois FJ, Charvier KF, Leriche A, Vézina JG, Côté M, Bélanger M. Blood pressure changes during sexual stimulation, ejaculation and midodrine treatment in men with spinal cord injury. BJU Int 2008; 101(3): 331– 337.

18. Sheel AW, Krassioukov AV, Inglis JT, Elliott SL. Autonomic dysreflexia during sperm retrieval in spinal cord injury: influence of lesion level and sildenafil citrate. J Appl Physiol 2005; 99(1): 53– 58.

19. Ekland MB, Krassioukov AV, McBride KE, Incidence of autonomic dysreflexia and silent autonomic dysreflexia in men with spinal cord injury undergoing sperm retrieval: implications for clinical practice. J Spinal Cord Med 2008; 31(1): 33– 39.

20. Kříž J, Rejchrt M. Autonomní dysreflexie – závažná komplikace u pacientů po poranění míchy. Cesk Slov Neurol N 2014; 77/ 110(2): 168– 173.

21. Ekland MB, Krassioukov AV, McBride KE, Elliott SL. Incidence of autonomic dysreflexia and silent autonomic dysreflexia in men with spinal cord injury undergoing sperm retrieval: implications for clinical practice. J Spinal Cord Med 2008; 31(1): 33– 39.

22. Sonksen J, Fode M, Lochner‑ Ernst D, Ohl DA. Vibratory ejaculation in 140 spinal cord injured men and home insemination of their partners. Spinal Cord 2012; 50(1): 63– 66.

23. Sonksen J, Sommer P, Biering‑ Sorensen F, Ziebe S, Lindhard A, Loft A et al. Pregnancy after assisted ejaculation procedures in men withspinal cord Injury. Arch Phys Med Rehabil 1997; 78(10): 1059– 1061.

24. Restelli AE, Bertolla RP, Spaine DM, Miotto A Jr, Borrelli M jr, Cedenho AP. Quality and functional aspects of sperm retrieved through assisted ejaculation in men with spinal cord injury. Fertil Steril 2009; 91(3): 819– 825. doi: 10.1016/ j.fertnstert.2007.12.060.

25. Patki P, Woodhouse J, Hamid R, Craggs M, Shah J. Effects of spinal cord injury on semen parameters. J Spinal Cord Med 2008; 31(1): 27– 32.

26. Linsenmeyer TA, Perkash I. Infertility in men with spinal cord injury. Arch Phys Med Rehabil 1991; 72(10): 747– 754.

27. Rutkowski SB, Middleton JW, Truman G, Hagen DL, Ryan JP. The influence of bladder management on fertility in spinal cord injured males. Paraplegia 1995; 33(5): 263– 266.

28. Naderi AR, Safarinejad MR. Endocrine profiles and semen quality in spinal cord injured men. Clin Endocrinol (Oxf) 2003; 58(2): 177– 184.

29. Rajasekaran M, Monga M. Cellular and molecular causes of male infertility in spinal cord injury. J Androl 1999; 20(3): 326– 330.

30. Brackett NL, Lynne CM, Aballa TC, Ferrell SM. Sperm motility from the vas deferens of spinal cord injured men is higher than from the ejaculate. J Urol 2000; 164(1): 712– 715.

31. Iremashvili VV, Brackett NL, Ibrahim E, Aballa TC, Lynne CM. A minority of men with spinal cord injury have normal semen quality – can we learn from them? A case‑ control study. Urology 2010; 76(2): 347– 351. doi: 10.1016/ j.urology.2009.11.063.

32. Basu S, Aballa TC, Ferrell SM, Lynne CM, Brackett NL. Inflammatory cytokine concentrations are elevated in seminal plasma of men with spinal cord injuries. J Androl 2004; 25(2): 250– 254.

33. Brackett NL, Ibrahim E, Grotas JA, Aballa TC, Lynne CM. Higher sperm DNA damage in semen from men with spinal cord injuries compared with controls. J Androl 2008; 29(1): 93– 99.

34. Beretta G, Chelo E, Zan A. Reproductive aspects in spinal cord injured males. Paraplegia 1989; 27(2): 113– 118.

35. Siosteen A, Forssman L, Steen Y, Sullivan L, Wickström I.Quality of semen after repeated ejaculation treatment in spinal cord injury men. Paraplegia 1991; 28(2): 96– 104.

36. Hamid R, Patki P, Bywater H, Shah PJ, Craggs MD. Effects of repeated ejaculations on semen characteristics following spinal cord injury. Spinal Cord 2006; 44(6): 369– 373.

37. Sonksen J, Ohl DA, Giwercman A, Biering‑ Sorensen F, Skakkebaek NE, Kristensen JK. Effect of repeated ejaculation on semen quality in spinal cord injured men. J Urol 1999; 161(4): 1163– 1165.

38. Momen MN, Fahmy I, Amer M, Arafa M, Zohdy W, Naser TA. Semen parameters in men with spinal cord injury: changes and etiology. Asian J Androl 2007; 9(5): 684– 689.

39. Engh E, Clausen OPF, Purvis K, Stien R. Sperm quality assessed by flow cytometry and accessory sex gland function in spinal cord injured men after repeated vibration‑induced ejaculation. Paraplegia 1993; 31(1): 3– 12.