Study design: Retrospective chart review. Objective: To identify factors in addition to level of injury (LOI) that may predict ejaculation by penile vibratory stimulation (PVS) in spinal cord injured males. Setting: Major urban medical school and teaching hospital. Materials and methods: Presence of a bulbocavernosus response (BCR) and a hip¯exor response (HR) before PVS (n=123 patients), and somatic responses during PVS (n=204 trials performed on a subset of 44 patients) were evaluated for their frequency of occurrence on trials with and without ejaculation. Results: Overall ejaculation success rates for cervical, T1 ± T6, and T7 ± T12 LOI were 71%, 73%, and 35%, respectively. Eighty per cent of patients who were positive for both BCR and HR ejaculated with PVS, while only 8% of patients who were negative for both BCR and HR ejaculated with PVS. For cervical injuries, BCR and HR were no more predictive of ejaculation by PVS than LOI alone. T1 ± T6 patients were more likely to ejaculate when at least one re¯ex was present. T7 ± T12 patients with no BCR were unlikely to ejaculate by PVS. Except for abdominal contractions, somatic responses were not present in the majority of PVS trials. When they were present, however, they occurred in a high percentage of ejaculation trials: withdrawal response (hip¯exion, knee¯exion and thigh adduction) (90%), piloerection (84%), extremity spasms (83%), thigh abduction (80%), and thigh adduction (72%). Conclusion: We recommend that patients with cervical injuries initially undergo PVS. Patients with T1 ± T6 LOI with at least one re¯ex present, and patients with T7 ± T12 LOI with both re¯exes, or only BCR present, may undergo PVS. Certain somatic/autonomic responses, when seen, may help in deciding whether to continue with a given trial, or give a repeat trial, of PVS.
not gender specific). Among all cancer centers, only 60% include information on fertility preservation specifically directed toward men, such as sperm cryopreservation. Survivorship information on family building after cancer was available on 32% of cancer center web sites. State population density had no significant effect on whether a web site included risks of treatment on fertility (p¼0.90) or information on fertility preservation (p¼0.29).CONCLUSIONS: Forty percent of NCI designated cancer center web sites do not discuss options for male fertility preservation, and over one-third make no mention of the ramifications of cancer treatment on male fertility. Given the increasing recognition of the importance of oncofertility in cancer survivorship, more education should be available about options for fertility preservation, particularly among men.References: [1] There are 68 NCI designated cancer centers, of which 61 engage in clinical activity. Cleveland Clinic Taussig Cancer Institute was included as a separate data point although it is also a member of the Case Comprehensive Cancer Center, for final n¼62.
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