Nocturnal penile tumescence and rigidity (NPTR) findings in spinal cord injured men with erectile dysfunction

Abstract

This prospective study aimed at determining whether nocturnal penile tumescence and rigidity (NPTR) findings correlate to the neurologic disorders in spinal cord injured (SCI) patients suffering from erectile dysfunction (ED). A total of 25 acute SCI male patients with post-traumatic ED underwent neurological, electrophysiological and urodynamic examinations, respectively, as well as NPTR recordings. The mean value for rigidity (R), tumescence (T) and duration (D) during NTPR tests were 83.3%, 3.3 cm, 6.4 min in patients with a complete lesion above the sacral (S2-S4) spinal cord (n ¼ 10), 46.1%, 1.6 cm, 5.5 min in patients with a complete lesion involving the sacral metameres (n ¼ 5) and 89.8%, 3.8 cm, 29 min in patients with an incomplete suprasacral lesion (n ¼ 7). The differences among these groups were statistically significant (Po0.05). Patients with lesions involving both sacral and thoracolumbar spinal cord showed no erections (n ¼ 3). We found four NTPR patterns: (1) normal R and T, short D; (2) weak R and T, short D; (3) normal R, T and D; and (4) no erections, which can be assigned to different levels and completeness of spinal cord lesions. Nocturnal erections of normal quality need preservation of thoracolumbar and sacral neuronal control as well as partially intact connections of the spinal erection centres with brain areas responsible for sexual arousal.

Prediction of sexual function following spinal cord injury: a case series

“…Both men and women with UMN lesions affecting the sacral spinal segments have reflex genital arousal. Men with SCI and UMN syndrome are more likely to have reflex erections with projectile ejaculation [2,[17][18][19]. They will be more responsive to phosphodiesterase inhibitors for reliable erections [20,21], and to PVS for ejaculation [2,22,23] than men with LMN syndromes.…”

Increased Cavernous Expression of Transforming Growth Factor-β1 and Activation of the Smad Signaling Pathway Affects Erectile Dysfunction in Men with Spinal Cord Injury

“…Nocturnal penile tumescence (NPT) is known to be involved in cavernous oxygenation and to suppress TGF‐β1‐induced cavernous fibrosis by increasing oxygen tension [19]. SCI patients have abnormal results on the NPT test, and patients with lesions on the sacral erection center show the most disturbed NPT recordings, with reduced rigidity, tumescence, and duration [20]. It has also been reported in animal models of cavernous nerve injury that increases in hypoxia‐inducible factor‐1α, a transcription factor related to hypoxia, and TGF‐β1 are noted in the corpus cavernosum tissue [11,12,21].…”

Erectile Dysfunction and Obstructive Sleep Apnea: A Review

“…Nocturnal penile tumescence (NPT) can regulate oxygen-required biological processes to protect the integrity of the corpora cavernosa ( 74 ). Although the exact regulatory mechanism of NPT is still unclear, some studies have shown that NPT may be related to neurovascular mechanisms and hormone regulation ( 75 ). A diminished or an absence of erections is thought to result from a decrease in REM sleep in patients with OSA ( 76 ).…”