Bladder Neck Incompetence in Patients With Spinal Cord Injury: Significance of Sympathetic Skin Response

Rodic, Biljana; Curt, Armin; Dietz, Volker; Schurch, Brigitte

doi:10.1016/s0022-5347(05)67729-4

Cited by 36 publications

(11 citation statements)

References 19 publications

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“…5 RE occurs in different conditions in which the bladder neck is weakened or open. This usually arises when the sympathetic outflow to the bladder neck is reduced, such as in patients with a lower motor neuron lesion at the T10-L2 spinal segment (causing flaccidity) 4,5,19 or those on alpha-blocking agents. 20 RE has also been described as a side effect of intradetrusor botulinum toxin injection, possibly due to the spread of toxin to the bladder neck.…”

Section: Discussionmentioning

confidence: 99%

Evidence of a new pattern of ejaculation in men with spinal cord injury: ejaculation dyssynergia and implications for fertility

Mieusset

2016

Spinal Cord

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Objectives: To describe the presence of sperm in the prostatic urethra as a stand-alone ejaculation entity and to assess its characteristics. Methods: Thirty-three patients with anejaculation during sexual stimulation were enroled. Penile vibratory stimulations were carried out following bladder catherization and instillation of a pink buffering medium (Ferticult). Two-step catheterisation was then performed: a catheter was inserted through the urethral sphincter into the prostatic urethra to aspirate its content, and then bladder catheterisation was performed to collect the Ferticult. The procedure was repeated in some patients after at least 1 week. The characteristics of the semen collected from each organ were analysed and compared. Results: A total of 42 trials were obtained from 22 patients. Sperms were found in the prostatic urethra in 21 samples (50%) from 12 patients (11 with spinal cord injury, 1 with diabetes). The colour of all 21 prostatic urethra sperm samples differed from the Ferticult. Sperm motility was greater in 8 samples, sperm count was higher in 10 and pH was different in 10, compared with the bladder samples. The higher overall quality of the sperm allowed cryopreservation in 10 prostatic urethra samples compared with only 5 bladder samples. Four of the five patients who underwent repeated trials had a reproducible pattern of prostatic urethra ejaculation. Conclusion: The presence of sperm in the prostatic urethra most probably results from 'ejaculation dyssynergia', a lack of coordination between bladder neck and external sphincter. Sperm from the prostatic urethra should be systematically sought to improve the outcome of assisted reproduction.

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Section: Discussionmentioning

confidence: 99%

Evidence of a new pattern of ejaculation in men with spinal cord injury: ejaculation dyssynergia and implications for fertility

Mieusset

2016

Spinal Cord

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“…Unfortunately, the utility of cortical SEPs after bladder neck/posterior urethra stimulation is limited by unrecognizable response in a proportion of controls [37], although concomitantly recorded palmar SSR demonstrates continuity of the sensory pathways from the bladder neck/posterior urethra up to the cervical spinal cord level [17]. This test and perineal SSR may serve to assess function of the thoracolumbar spinal sympathetic, which is important for the function of the (smooth) internal urethral sphincter muscle (ie, bladder neck competence) [38]. In patients with multiple sclerosis [39] or other spinal cord disease [40] and neurogenic bladder, a substantially prolonged MEP central conduction time on transcranial magnetic stimulation and EAS muscle detection demonstrates a lesion to the motor pathways innervating sacral myotomes.…”

Section: Infrapontine-suprasegmental (Spinal) Diseasementioning

confidence: 98%

Neurophysiologic Testing in Neurogenic Bladder Dysfunction: Practical or Academic?

Podnar

2010

Curr Bladder Dysfunct Rep

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For the diagnosis of neurogenic bladder, in addition to clinical assessment, neurophysiologic testing may be useful. Neurophysiologic tests are more useful in patients with sacral compared with suprasacral disorders. Anal sphincter electromyography (EMG) is the most useful diagnostic test, particularly for focal sacral lesions and atypical parkinsonism. Another clinically useful method that tests the sacral segments and complements EMG is the sacral (penilo/clitoro-cavernosus) reflex. Kinesiologic EMG is useful to demonstrate detrusor sphincter dyssynergia. Somatosensory-evoked potential and motor-evoked potential studies may be useful to diagnose clinically silent central lesions. The utility of cortical somatosensoryevoked potential in bladder/urethra stimulation is limited by technical difficulties that can be partially overcome by the concomitant recording of a palmar sympathetic skin response. Sympathetic skin response recorded from the saddle region is also useful for testing the lumbosacral sympathetic system. A clinically useful neurophysiologic test for evaluating the sacral parasympathetic system is still lacking.

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“…On les retrouvera donc dans les neuropathies diabétiques, la sclérose en plaques... [6][7][8]. Elle est très fréquente dans les atteintes médullaires, soit par l'incoordination entre sphincter strié urétral et col vésical (dyssynergie neurologique), soit par l'incompé-tence ou la béance du col [9][10][11].…”

Section: Définitions Et éTiologiesunclassified

Éjaculation rétrograde et anéjaculation

et al. 2007

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L'anéjaculation et l'éjaculation rétrograde font partie des dysfonctions éjaculatoires, leur fréquence est moindre que l'éjaculation prématurée. Elles peuvent être responsables d'anorgasmie et engendrer des problèmes d'infertilité. L'anéjaculation peut être congénitale ou acquise, fréquemment au décours de chirurgie prostatique ou de maladies neurologiques, en particulier médullaires. Les origines psychologiques ne doivent pas être ignorées. Les mêmes étiologies sont souvent retrouvées en cas d'éjaculation rétrograde. Différentes approches thérapeutiques existent en fonction de l'étio-logie. La stimulation pénienne vibratoire (vibromassage) et la stimulation pharmacologique sympathomimétique (midodrine) représentent souvent un traitement de première intention, qui permet un recueil de sperme sans nécessité d'électroéjaculation ou de techniques chirurgicales, plus contraignantes. La psychothérapie sera proposée en cas de nécessité. Le traitement par midodrine présente une certaine efficacité dans le traitement de l'éjaculation rétrograde, par fermeture du col vésical.Abstract: Ejaculatory disorders are common male sexual dysfunctions. Although premature ejaculation has been extensively studied, anejaculation and retrograde ejaculation are lesser known, though they have been associated with anorgasmia and reproductive disorders. Anejaculation can be congenital or acquired and is mostly seen after prostate surgery and neurological diseases (spinal cord injuries) or is related to psychogenic factors. Generally, the same causes are associated with retrograde ejaculation. The management of these disorders depends on aetiology. Penile vibratory stimulation and pharmacological stimulation, using sympathomimetic drugs, such as midodrine, are increasingly recommended as first-line treatments. Electroejaculation and surgical procedures should only be used when necessary. Behavioural therapy is sometimes indicated when psychogenic or relationship factors are identified. By inducing bladder neck closure, midodrine can prove effective in the treatment of retrograde ejaculation.

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Bladder Neck Incompetence in Patients With Spinal Cord Injury: Significance of Sympathetic Skin Response

Cited by 36 publications

References 19 publications

Evidence of a new pattern of ejaculation in men with spinal cord injury: ejaculation dyssynergia and implications for fertility

Evidence of a new pattern of ejaculation in men with spinal cord injury: ejaculation dyssynergia and implications for fertility

Neurophysiologic Testing in Neurogenic Bladder Dysfunction: Practical or Academic?

Éjaculation rétrograde et anéjaculation

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