A paraplegic fathering a child after an intrathecal injection of neostigmine: case report

Otani, Toshikazu; Kondo, Atsuo; Takita, Tohru

doi:10.1038/sc.1986.6

Cited by 10 publications

(8 citation statements)

References 14 publications

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“…De même, l'utilisation de Gutron ® , disponible en comprimés oraux, permet de préserver l'autonomie des patients et devrait être encouragée. Puisque le produit vise le système sympathique par opposition à l'ensemble du système autonomique, ses effets secondaires paraissent limités [25][26][27]32,33] comparés aux précédentes molécules anticholinergiques [3][4][5][6][7][8][9][10]. L'assistance médicale n'est donc plus une absolue nécessité pour obtenir une éjaculation chez l'homme blessé médullaire, qui peut se suffire à luimême (ou avec l'aide de sa partenaire) pour tenter des expériences dans l'intimité de son domicile pour revivre une sexualité post-lésionnelle pourvue de plaisir et de paroxysme sexuels.…”

Section: Resultsunclassified

“…En passant des injections intrathécales de néostigmine ® [3][4][5][6][7] aux injections sous-cutanées de physostigmine ® [8][9][10], à l'électro-éjaculation [11][12][13][14], au vibromassage [15][16][17][18] et même aux tests à la stimulation naturelle avec ou sans biofeedback [19][20][21], les traitements et les techniques se sont développés à travers les années pour permettre à la très vaste majorité des hommes paraplégiques et tétra-plégiques d'obtenir aujourd'hui une éjaculation [22,23].…”

Section: Introductionunclassified

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Sensations éjaculatoires chez l’homme paraplégique et tétraplégique durant la stimulation par vibromassage avec et sans Gutron®

et al. 2008

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Depuis les travaux sur l'utilisation du Gutron ® en Europe et au Canada (Québec), nous avons étudié les sensations somatiques et autonomiques pouvant être associées à l'éjaculation chez les hommes blessés médullaires. Puisque l'éjaculation est associée à une activité sympathique, que le Gutron ® est un alphastimulant et que l'activité sympathique peut être transmise par divers circuits nerveux, nous avons émis l'hypothèse que l'éjaculation serait associée à des perceptions autonomiques malgré les lésions. Un total de 41 hommes tétraplégiques et paraplégiques avec des lésions situées de C2 à T2 et de T3 à T6 ont obtenu des éjaculations par vibromassage avec et sans Gutron ® . Les mesures de la tension artérielle systolique (TAS) ont montré des hausses de 51 mmHg (113 à 164 mmHg) chez les sujets tétraplégiques lors de l'éjaculation, avec peu de différences entre les patients utilisant le Gutron ® et ceux ne l'utilisant pas. Chez les hommes paraplégiques, l'éjaculation avec Gutron ® montre des hausses de TAS de 39 mmHg, mais la TAS n'augmente que de 13 mmHg chez les paraplégiques éjaculant sans Gutron ® . La fréquence cardiaque diminue chez tous les sujets lors de l'éjaculation (de 8 à 24 b/min) mais de façon plus importante chez les paraplégiques sous Gutron ® . Les sensations physiologiques sont perçues plus fréquemment en cas d'éjaculation par opposition à la stimulation sexuelle sans éjaculation (test négatif) et plus fréquemment chez les hommes utilisant le vibromassage seul plutôt que couplé avec le Gutron ® . Les sensations physiologiques (cardiovasculaire, musculaire, autonomique) sont plus fréquentes que les sensations orgasmiques (relaxante, paroxystique, intime). Ces résultats suggèrent que le Gutron ® affecte moins les hommes tétraplégiques que les paraplégiques, probablement parce que l'activité sympathique est maximale chez le tétraplégique lors de l'éjaculation en raison de l'hyperréflexie autonome. Les sensations semblent par ailleurs plus généra-lisées en cas d'éjaculation par vibromassage seul et ne sont donc pas uniquement attribuables à un effet secondaire du Gutron ® . Les implications cliniques de ces résultats sur l'autonomie des hommes blessés médullaires sont discutées.Ejaculatory sensations during vibrator and midodrine stimulation in men suffering from damage to the spinal cord Abstract: Since the first studies on midodrine hydrochloride, carried out in Europe and Canada (Quebec), we have been interested in the somatic and autonomic sensations that might be associated with ejaculation in men suffering from lesion to the spinal cord. Since ejaculation is associated with sympathetic activity, since midodrine is an alpha stimulating drug and since sympathetic activity can be transmitted to the brain through several neural pathways, we hypothesized that ejaculation might be associated with autonomic perceptions despite the spinal lesions. A total of 41 tetraplegic and paraplegic men with lesions located between C2-T2 and T3-T6 achieved ejaculation with penile vibrator stimulation with and with...

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Section: Resultsunclassified

Section: Introductionunclassified

Sensations éjaculatoires chez l’homme paraplégique et tétraplégique durant la stimulation par vibromassage avec et sans Gutron®

et al. 2008

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“…13 Four pregnancies were reported, the last one in 1985. 14 Because of serious adverse e ects (critical blood pressure increase with danger of haemorrhagic insults) this drug now is obsolete. The related drug physostigmine has less side e ects, mainly a possible blood pressure decrease and seldom nausea.…”

Section: Methods and Patientsmentioning

confidence: 99%

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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“…7 Retrograde ejaculation is common, due to sympathetic denervation of the bladder neck. The ejaculatory failure has prompted the development of various methods for ejaculation procurement, such as intrathecal injection of neostigmine, 8 subcutaneous physostigmine, 9 microsurgical aspiration techniques of sperm from epididymis and testes, 10 direct stimulation of the hypogastric nerve, 11 penile vibratory stimulation (PVS) 3,12 ± 14 and electroejaculation (EEJ). 13 ± 21 With EEJ, a low-current stimulation of the ejaculatory organs via a rectal probe is done, causing induction of seminal emission.…”

Section: Introductionmentioning

confidence: 99%

Treatment of male infertility due to spinal cord injury using rectal probe electroejaculation: the Israeli experience

et al. 2001

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Study design: Male infertility caused by anejaculation is common among patients with spinal cord injury (SCIP). The fertility options for SCIP have improved impressively over the past 10 years. We present the Israeli experience in the treatment of infertility in a large series of SCIP. The issues which are addressed include the treatment of ejaculatory dysfunction, seminal quality and fertility management in SCIP. Setting: Sexual rehabilitation clinic, Neuro-Rehabilitation department, Sheba Medical Center, Israel. Methods: Between June 1992 and May 1998, a total of 84 consecutive SCIP were treated in our clinic with electro-ejaculation (EEJ), representing a sample of the SCIP population, composed mostly of young men traumatically injured. The patients have sustained dierent levels and completeness of spinal injury. Among the patients 33 were interested in achieving pregnancy (39.3%), while the rest were interested in determining fertility potential for family. With EEJ, a low-current stimulation of the ejaculatory organs via a rectal probe is done. The collected semen is used for fertility determination or for fertilization. Results: Eighty-four patients were treated by EEJ. Mean age was 31.3 and mean age at injury was 21.7. There were 29 cervical, 50 thoracic and ®ve lumbar lesions. Sixty-three had complete injury (ASIA A) and 21 incomplete (ASIA B -15, ASIC C -5, ASIA D -1). Fifty-nine had upper motor neuron lesions, and 25 had lower motor neuron. A total of 355 stimulations were performed. Ejaculate was obtained in all patients in 350 stimulations (98.6%), and sperm was present in 74 patients (88.1%) in 296 of the stimulations (83.4%). Fairly good numbers of spermatozoa were obtained, whereas sperm motility and morphology of spermatozoa were low in most cases. A signi®cant dierence in sperm count, motility and morphology was noted between antegrade and retrograde samples. No signi®cant improvement in sperm quality after four repeated consecutive stimulations was noted in 38 SCIP. Side eects were minor and encountered in 16 patients (19.1%). Out of 33 couples who wished to achieve pregnancy, 26 reached the stage of insemination. Four pregnancies were achieved after 33 cycles of InUterine-Insemination (pregnancy rate 28.6% per couple), and 15 after 68 cycles of In-VitroFertilization (micromanipulation) (pregnancy rate of 68.75% per couple). In all, of 101 conception attempts 23 were successful, resulting in pregnancies in 18 couples, and accounting for an overall pregnancy rate of 70% per couple. Conclusion: The high percentage of pregnancies imply that, despite the typically poor sperm motility noted in EEJ, rectal probe EEJ combined with assisted reproductive techniques, and performed by a team approach, is an ecient and safe technique for treating infertility among SCIP.

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A paraplegic fathering a child after an intrathecal injection of neostigmine: case report

Cited by 10 publications

References 14 publications

Sensations éjaculatoires chez l’homme paraplégique et tétraplégique durant la stimulation par vibromassage avec et sans Gutron®

Sensations éjaculatoires chez l’homme paraplégique et tétraplégique durant la stimulation par vibromassage avec et sans Gutron®

Conservative and surgical semen retrieval in patients with spinal cord injury

Treatment of male infertility due to spinal cord injury using rectal probe electroejaculation: the Israeli experience

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