The influence of bladder management on fertility in spinal cord injured males

Rutkowski, Sue; Middleton, JW; Truman, George; Hagen, DL; Ryan, John P.

doi:10.1038/sc.1995.59

Cited by 50 publications

(29 citation statements)

References 6 publications

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“…[9][10][11] Currently the two most popular methods of sperm retrieval are vibro-and electro-ejaculation. Irrespective of the technique, the sperm quality has consistently been reported as poor in all series evaluating the semen of SCI men.…”

Section: Introductionmentioning

confidence: 99%

Effects of repeated ejaculations on semen characteristics following spinal cord injury

et al. 2005

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Study design: Prospective randomised controlled study. Objective: To evaluate the effects of repeated ejaculation on semen characteristics following spinal cord injury (SCI) in a prospective randomised controlled study. Setting: Spinal Research Centre, Stanmore, UK and Institute of Urology and Nephrology, London, UK. Methods: A total of 74 patients with SCI above T10 were tested by vibro-ejaculation using a Ferticare penile vibrator (Multicept A/S Horsholm, Denmark) using a standardised technique. The ejaculate was examined according to WHO protocol. The successfully vibro-ejaculated subjects (n ¼ 32) were randomised into a study group (n ¼ 18) and a control group (n ¼ 14). The patients in the study group vibro-ejaculated weekly for 3 months with semen analysis performed at baseline and then monthly. The control group vibro-ejaculated at baseline and at the end of the 3-month period. Two experienced observers performed the semen analysis independently. All measures were compared for statistical significance across the two groups at the beginning and at the end of the 3-month period using a two-tailed student t-test. Significance was determined at the 95% confidence interval (Po0.05). Results: In total, 10 patients in the study group and nine in the control group have completed the study so far. Six patients have dropped out of the study group and three from the control group for varied reasons. Two patients are currently enrolled in the study and control groups. The morphology and forward progression of sperm shows a statistically significant increase in the study group. The motility improves but is not statistically significant in the study group. No significant adverse effects were reported. Conclusions: We have shown in this unique randomised controlled study that repeated ejaculation does improve the sperm characteristics in SCI patients. It is suggested that SCI men should undergo repeated ejaculation for at least 3 months before trying intravaginal or intrauterine insemination techniques. If this fails then in vitro fertilisation can be used. This method promotes natural conception, is intimate and cost effective.

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Section: Introductionmentioning

confidence: 99%

Effects of repeated ejaculations on semen characteristics following spinal cord injury

et al. 2005

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“…35 Contrary, a decrease in sperm motility related to a lower level of the lesion is found by other researchers. 36 The last group also reports a better sperm motility in patients who evacuate by self catheterisation, as compared to patients who perform triggered voiding. They suppose that high pressure in the prostatic urethra during the triggered voiding causes urine in¯ux into the adnexae.…”

Section: Discussionmentioning

confidence: 95%

Conservative and surgical semen retrieval in patients with spinal cord injury

et al. 1997

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Assisted semen retrieval was applied in 219 men with spinal cord injury (212 supranuclear, seven infranuclear lesions). Vibrostimulation in supranuclear lesions was successful in 133, and in ®ve more after physostigmine injection. Electroejaculation was successful in all seven infranuclear lesions and in four supranuclear patients failing with vibrostimulation. Eight more supranuclear patients responded to electroejaculation and physostigmine. Surgical retrieval was applied in 27 patients. Nine Wagenknecht spermatoceles showed only one success, from all 18 implanted Brindley reservoirs semen could be collected. Three patients, in whom no pregnancy could be induced after Brindley reservoir implantation, had testicular sperm aspirated. In 109 patients who wanted to have o spring, 73 pregnancies could be induced in 46 couples, leading to 54 births (four twins), 16 abortions and three pregnancies. Conservative semen retrieval was possible in 82 of these men (63 pregnancies in 37 couples) and surgical methods were used in 27 (10 pregnancies in nine couples).

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“…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. 22 For this reason, education emphasising appropriate bladder management, prevention and early treatment of urinary tract infection and reduction in scrotal temperature, is an important component of the clinics' approach.…”

Section: Discussionmentioning

confidence: 99%

“…The electrical stimulation parameters used and detail of both the vibroejaculation and electroejaculation procedures have been previously described. 22 Bladder neck tamponade A technique of bladder neck tamponade 23,24 to prevent retrograde emission during electroejaculation procedures has been used in this clinic since October 1993. The technique used is simpler than some methods described.…”

Section: Electroejaculationmentioning

confidence: 99%

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

et al. 1999

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Objectives: To review the outcomes of management of male infertility following spinal cord injury in a specialised fertility clinic. Study Design: Retrospective review of medical records. Setting: The Fertility Clinic of a 45-bed spinal cord injury service in New South Wales, Australia. Methods: The medical and fertility clinic records of 113 males who attended the clinic between 1987 and 1997 were reviewed. Results: The rates of semen retrieval using vibroejaculation and electroejaculation were 67% and 97% respectively. Thirty-one individuals (37%) and their partners sought assistance with the primary aim of achieving a pregnancy. Intravaginal insemination (IVI) undertaken at home following vibroejaculation resulted in a pregnancy rate per cycle of 22%. Electroejaculation and IVI proved less successful with a pregnancy rate per cycle of only 5%, although with intrauterine insemination (IUI) this rate improved to 30%. Micromanipulation in vitro fertilisation (IVF) procedures, primarily intracytoplasmic sperm injection, were used in 18 couples resulting in a pregnancy rate per cycle of 19%. In the 31 couples there have been a total of 17 pregnancies in 97 cycle attempts for an overall pregnancy rate per cycle of 18% and a cumulative pregnancy rate per couple of 55%. Twelve of the pregnancies have resulted in 14 live births (including two sets of twins), there were three pregnancies ongoing at the date of review and there have been two spontaneous abortions. Conclusion: The bene®ts of a specialised fertility clinic o ering a comprehensive, clientfocused approach with education, fertility assessment and a range of semen retrieval and assisted reproduction options, are highlighted.

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The influence of bladder management on fertility in spinal cord injured males

Cited by 50 publications

References 6 publications

Effects of repeated ejaculations on semen characteristics following spinal cord injury

Effects of repeated ejaculations on semen characteristics following spinal cord injury

Conservative and surgical semen retrieval in patients with spinal cord injury

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

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