Neurological correlations of ejaculation and testicular size in men with a complete spinal cord section.

Abstract

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 ...

Medical treatment of male infertility

“…For treatment of patients with AE caused by SCI, the parasympathomimetics physostigmine and neostigmine had been used with limited success (Kamischke & Nieschlag, 1999b). Therefore, because of their side effects profile and lower success rate compared with electrovibration stimulation and electroejaculation, neostigmine and physostigmine should not be considered as treatment of first choice in the treatment of AE in patients with SCI (Chapelle et al, 1988;Linsenmeyer & Perkash, 1991;Kamischke & Nieschlag, 2002).…”

Erectile function and male reproduction in men with spinal cord injury: a review

“…The authors observed that there was less likelihood of ejaculation if the lesion was between T10 and L4. Other investigators employed either subcutaneous injection of physostigmine (Chapelle et al, 1988) or intrathecal injection of neostigmine (Piera, 1973) (Table 1). However, the latter treatments were abandoned by most physicians because of a high incidence of severe side effects such as AD.…”

Update on medical treatment of ejaculatory disorders1

“…However, neostigmine has to be judged obsolete because of severe side‐effects. Although physostigmine in SCI patients is significantly more effective (56% overall success) than the alpha agonists in non‐SCI patients, physostigmine also has potentially severe side‐effects and, with one exception (Chapelle et al ., 1988), has only been applied in a clinical setting. To reduce side‐effects physostigmine (1–2 mg s.c.) should only be applied after pre‐treatment with 20–40 mg butylhyocine bromide and under careful monitoring of signs of autonomic dysreflexia (Linsenmeyer & Perkash, 1991) in SCI patients.…”