Fertility of Spinal Cord Injured Males: Effect of Genitourinary Infection and Bladder Management on Results of Electroejaculation

Abstract

Thirty-eight men undergoing electroejaculation (EEJ) procedures for anejaculatory infertility were examined for the presence or absence of infection in urine and semen. In 29 spinal cord injury patients, a high incidence of infected urine and infected semen (41% and 56%, respectively) was seen, in contrast to patients with normal bladder function (0% and 11%). Urinary infection was associated with slightly lower sperm quality and lower pregnancy rates (10% vs 30% in the presence of sterile urine). Semen infection had no effect on sperm counts or pregnancy rates. If intermittent self-catheterization (ISC) was used to empty the neurogenic bladder, slightly better sperm quality was seen, the total failure rate was less, and much better pregnancy rates (44%) resulted than for patients using an alternative bladder management (7%). Antibiotics did not reduce the incidence of urine or semen infection, but did improve sperm counts slightly. Continuous prophylaxis was associated with bacterial resistance to many oral antibiotics and had no advantage over a short course of antibiotics prior to the procedure. Despite the above associations, the sperm quality in our patient population was never normal compared with that of men who ejaculate normally. We conclude that the low sperm quality seen in electroejaculation specimens from spinal cord injured males is not due entirely to infection or to the type of bladder management. Short courses of antibiotics, instead of continuous antibiotic prophylaxis, may be beneficial. Intermittent catheterization is superior to other methods of neurogenic bladder management in maintaining the fertility of spinal cord injured men.

A comprehensive approach to the management of male infertility following spinal cord injury

“…53 The method of bladder management used has also been shown to a ect semen quality. 54 In a previous study by this clinic, both method of bladder management and neurological level proved to be signi®cant factors a ecting the presence of motile sperm. Low pressure bladder emptying by catheter drainage (either permanent indwelling catheter or intermittent self catheterisation) resulted in a higher percentage of motile sperm compared to individuals using re¯ex voiding or straining.…”

Testicular sperm retrieval and intra cytoplasmic sperm injection provide favorable outcome in spinal cord injury patients, failing conservative reproductive treatment

“…The mean age of the female partners was 34.5 ± 4.66 years (range 26-44). The mean age at injury of the male partners was 21.7±4.3 years and the average interval till the ART procedure was carried out was 7.6±2.1 years (range [5][6][7][8][9][10][11][12][13][14][15][16].…”

A case of rapid deterioration in sperm quality following spinal cord injury

“…Studies on various methods of bladder management have confirmed that intermittent achieved a higher percentage of motile sperms as compared to high pressure voiding by reflex or straining. 5,6 Ohl et al 5 have also concluded that urinary infection is associated with slightly lowersperm quality and lower-pregnancy rates as compared to presence of sterile urine, 10 versus 30%. Decline in semen quality appears to begin within the first few weeks of injury, but the exact point in time when deterioration starts has not yet been determined.…”