Bulbocavernosus Reflex to Stimulation of Prostatic Urethra in Patients with Lifelong Premature Ejaculation

Zhou, Chuanen; Jiang, Xianzhou; Zhang, Xu; Guo, Lihua; Chen, Jing; Wang, Hongqiang; Zhang, Dongqing; Shi, Benkang

doi:10.1111/j.1743-6109.2009.01646.x

Cited by 9 publications

(9 citation statements)

References 39 publications

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“…However, studies conducted in humans have also shown that direct stimulation of the bulbous and prostatic urethra can trigger reflex BSM-EMG bursting, which is similar to ELRs (42,59). In addition, distension of the bulbous urethra produced rhythmic BSM-EMG activity, which was reproducible and which disappeared after anesthetization of the bulbous urethra, further suggesting that urethral afferents may also play a role in ejaculation (42).…”

Section: Discussionmentioning

confidence: 93%

Characterization of bulbospongiosus muscle reflexes activated by urethral distension in male rats

Tanahashi

Venkateswarlu²,

Thor³

et al. 2012

American Journal of Physiology-Regulatory, Integrative and Comp

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The urethrogenital reflex (UGR) is used as a surrogate model of the autonomic and somatic nerve and muscle activity that accompanies ejaculation. The UGR is evoked by distension of the urethra and activation of penile afferents. The current study compares two methods of elevating urethral intraluminal pressure in spinalized, anesthetized male Sprague-Dawley rats (n = 60). The first method, penile extension UGR, involves extracting the penis from the foreskin, so that urethral pressure rises due to a natural anatomical flexure in the penis. The second method, penile clamping UGR, involves penile extension UGR with the addition of clamping of the glans penis. Groups of animals were prepared that either received no additional treatment, surgical shams, or received bilateral nerve cuts (4 nerve cut groups): either the pudendal sensory nerve branch (SbPN), the pelvic nerves, the hypogastric nerves, or all three nerves. Penile clamping UGR was characterized by multiple bursts, monitored by electromyography (EMG) of the bulbospongiosus muscle (BSM) accompanied by elevations in urethral pressure. The penile clamping UGR activity declined across multiple trials and eventually resulted in only a single BSM burst, indicating desensitization. In contrast, the penile extension UGR, without penile clamping, evoked only a single BSM EMG burst that showed no desensitization. Thus, the UGR is composed of two BSM patterns: an initial single burst, termed urethrobulbospongiosus (UBS) reflex and a subsequent multiple bursting pattern (termed ejaculation-like response, ELR) that was only induced with penile clamping urethral occlusion. Transection of the SbPN eliminated the ELR in the penile clamping model, but the single UBS reflex remained in both the clamping and extension models. Pelvic nerve (PelN) transection increased the threshold for inducing BSM activation with both methods of occlusion but actually unmasked an ELR in the penile extension method. Hypogastric nerve (HgN) cuts did not significantly alter any parameter. Transection of all three nerves eliminated BSM activation completely. In conclusion, penile clamping occlusion recruits penile and urethral primary afferent fibers that are necessary for an ELR. Urethral distension without significant penile afferent activation recruits urethral primary afferent fibers carried in either the pelvic or pudendal nerve that are necessary for the single-burst UBS reflex.

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Section: Discussionmentioning

confidence: 93%

Characterization of bulbospongiosus muscle reflexes activated by urethral distension in male rats

Tanahashi

Venkateswarlu²,

Thor³

et al. 2012

American Journal of Physiology-Regulatory, Integrative and Comp

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“…The decreasing intensity was considered as the critical value. The same procedure was repeated three times and all the critical values were recorded and averaged to estimate the sensory threshold of penile shaft (Yilmaz et al ., ; Zhou et al ., ).…”

Section: Methodsmentioning

confidence: 97%

Clinical characteristics and penile afferent neuronal function in patients with primary delayed ejaculation

et al. 2013

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SUMMARYPrimary delayed ejaculation (DE) is a relatively uncommon condition and has not been studied broadly. In this study, we aimed to investigate the clinical characteristics and penile afferent neuronal function using somatosensory evoked potentials in patients with primary DE. Twenty-four patients with primary DE and 24 age-matched normally potent men were enrolled in this study. Results indicated that patients with primary DE had remarkably higher frequency of masturbatory activity (especially, some with idiosyncratic styles), lower night emissions, longer intravaginal ejaculation latency time (IELT), higher anxiety and depression states (p = 0.010, p = 0.017, p < 0.001, p < 0.001, p < 0.001 respectively). In addition, the mean penile shaft sensory threshold values in the patients were considerably higher than those in the healthy men (p < 0.001). Mean latencies of dorsal nerve somatosensory evoked potential DNSEP were 4.32 ms longer in the DE group than those in the control group (p < 0.001). However, the latencies of glans penis somatosensory evoked potential (GPSEP) between the two group showed no significant difference (p = 0.985). At the same time, in comparison with the control group, the amplitudes of DNSEP were considerably lower in the DE group (p = 0.016), but not in the amplitudes of GPSEP (p = 0.934). This study indicates that the patients with primary DE appear to have penile shaft rather than glans hyposensitivity and hypoexcitability, and adaptation to a certain masturbatory technique (higher and idiosyncratic) may be related to the causes of primary DE, which is also associated with lower night emissions, longer IELT, higher anxiety and depression states.

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“…Indeed, based on psychopharmacological studies there is evidence that premature ejaculation is related to a diminished serotonergic neurotransmission, and 5-HT2 C or 5-HT1 A receptor disturbances. Interestingly, patients with lifelong PE might have hyperexcitable bulbocavernosus reflex to stimulation of prostatic urethra, which is probably an important factor for its etiology [29]. Acquired PE can be iatrogenic (i.e.…”

Section: Premature Ejaculationmentioning

confidence: 99%

Neurogenic Ejaculatory Disorders: Focus on Current and Future Treatments

Calabrò

Polimeni²,

Casella

et al. 2011

RPCN

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Ejaculation is a complex and still poorly understood neurological mechanism, at both spinal and cerebral levels as it is closely associated with orgasm. Physiologically, ejaculation is defined as the expulsion of seminal fluid from the urethral meatus and consists of two phases, namely emission and expulsion. Ejaculation is mediated by a spinal control center, referred to as a spinal pattern generator that coordinates sympathetic, parasympathetic and motor (somatic) outflows, integrating the latter with the inputs from the supraspinal sites in brainstem, hypothalamus and preoptic area. Premature ejaculation (PE) is the most common sexual dysfunction among young men, and it has been considered mostly psychogenic in origin, although it can be associated to diverse urological and neurological diseases. On the contrary, retrograde ejaculation and anejaculation are predominantly related to organic causes, particularly to neurogenic ones. Since ejaculation is mostly a spinal reflex, it is comprehensible that ejaculatory disorders are more frequent in spinal cord injury than in other neurological disorders. Over the past decades, research has focused on PE, and evidence from clinical studies showed a beneficial effect of antidepressants for the treatment of men with PE. Other ejaculatory disorders, especially painful ejaculation, have been less investigated and the proper therapy is still controversial. Aim of this review is to provide a comprehensive description of both currently available treatments and most promising future therapies, including assigned patents, for the neurogenic ejaculatory disorders.

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Bulbocavernosus Reflex to Stimulation of Prostatic Urethra in Patients with Lifelong Premature Ejaculation

Cited by 9 publications

References 39 publications

Characterization of bulbospongiosus muscle reflexes activated by urethral distension in male rats

Characterization of bulbospongiosus muscle reflexes activated by urethral distension in male rats

Clinical characteristics and penile afferent neuronal function in patients with primary delayed ejaculation

Neurogenic Ejaculatory Disorders: Focus on Current and Future Treatments

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