Three types of erection following complete spinal transection (at lower thoracic or thoracolumbar levels) in man are described. Reflex erection involves both corpus cavernosum and corpus spongiosum if the lower level of cord injury or lesional sector (LLLS) is cranial to T10/12, and involves only corpus cavernosum if the LLLS is caudal to T12/L2. Psychogenic erection may occur when the upper level of cord injury or lesional sector (ULLS) is caudal to T12 and when testicular sensation is normal. A mixed erection can occur when the ULLS is caudal to T10/12 and the LLLS cranial to S2.
Sutntnary. The authors describe a new therapy for paraplegic anejaculation.Sub-cutaneous injection of Physostigmine with certain precautions and with selected methods of application can be used for patients where there is the same indication for the use of an intrathecal injection of Neostigmine. The TI2-L2 myelomeres must be intact. The new treatment is easier to perform, and when the patient has experimented with three tests in our hospital without any problems, he is granted permission to apply this treatment at home, without any medical supervision.
SUMMARY This study was of 135 patients with a complete spinal cord section suffered from loss of ejaculation. The spinal cord injuries were classified following the upper and the lower limits of the lesion. The volume of the testes of the patients and of 13 normal control subjects were measured. Physostigmine allowed 75 patients to ejaculate and 15 of them procreated. The possibility of ejaculation after physostigmine mainly depended on the integrity of the T12-L2 metamers. The testicular volume was significantly smaller in patients with a lesion including the T12 metamer than in patients with a lesion sparing the T12 metamer. Six patients with a lesion including the T12 metamer had testicular atrophy. This suggests that T12 segment plays a role in testicular function in paraplegic patients.The sexual potency of paraplegic patients has received much attention and many extensive surveys are available in the literature.'`6 Although effective treatment of an ejaculation can now be offered to these patients,7-10 the number of those who have procreated remains low. " -13 This survey of 135 patients with a clinically complete spinal cord section was performed in order to define the neurological basis for the prognosis regarding procreation. The capacity to ejaculate is an obvious prerequisite, but its relationship to the level of the cord lesion remains imprecise. In addition fertility obviously depends on testicular activify, which has been shown to be altered in patients with a spinal cord injury.14-18 The volume of the testicle was chosen as a measure of testicular exocrine capacity,'9 20 since it can always be studied whether the patients are able to ejaculate or not. Methods SubjectsOne hundred and thirty five paraplegic patients were all examined by the same physician (PAC) with regard to the management of the sexual sequelae of their paraplegia. All wished very strongly to recover ejaculation, some of them were willing to procreate. The patients involved in this study suffered from a spinal cord section due to indirect trauma. The lesion was regarded as being complete on the basis of the clinical examination: below the level of the lesion sensory loss was complete and the patients were unable to perform the slightest voluntary movement. All were examined at least 6 months after the accident, by which time it was thought that no effects of spinal shock remained. The patients were aged 18 to 47 years and sustained spinal cord injury at an age ranging from 3 months to 41 years. The delay between the trauma and the first consultation ranged from 6 months to 33 years. Neurological examinationThe superior and inferior levels of the lesion were determined following a clinical neurological examination that has previously been described.2" 22 Briefly, the upper limit of the lesion is the highest metamer displaying paralysis. The lower limit of the lesion was determined using both somatic and vegetative reflexes by successively testing spinal reflex activities from segment S5 to the higher levels. The lower limit of the ...
A case of successful pregnancy following artificial insemination following intrathecal neostigmine injection in the wife of a complete traumatic paraplegic (T7-T8 to T11-T12) is described.
Testicular biopsies and hormone profiles were obtained from 23 paraplegic patients who had sustained a complete spinal cord section. The hormone profiles were normal, but patients with a spinal lesion including the TlO-L2 metameres showed a particular pattern of germinal cell abnormalities. The atrophy is multifactorial, but may well include destruction of the sympathetic innervation of the testis by the lesion.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.