Midodrine Improves Ejaculation in Spinal Cord Injured Men

Soler, J.-M.; Prévinaire, J G; Plante, Pierre; Denys, Pierre; Chartier‐Kastler, Emmanuel

doi:10.1016/j.juro.2007.07.047

Cited by 81 publications

(88 citation statements)

References 18 publications

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“…The T1-T5 and T5-T10 sympathetic outflows project respectively to the heart and to the large splanchnic circulatory bed, and are directly implicated in the cardiovascular control (autonomic dysreflexia, orthostatic hypotension and so on); 9,10 sympathetic fibres arising from T10 to L2 are involved in sphincteric functions (psychogenic erection, ejaculation, bladder neck dyssynergia and so on). [11][12][13][14] Our findings suggest that the assessment of sympathetic levels and sympathetic ZPP provides additional aid to the classification of thoracic SCI patients. Below the lesion, a sympathetic vasoconstrictor response was seen in all complete ASIA A patients with a UMN lesion.…”

Section: Discussionmentioning

confidence: 75%

“…These procedures stimulate the sympathetic nervous system, and can produce autonomic dysreflexia, with paroxysmal rise in both systolic and diastolic blood pressure, mostly in patients with lesion above T6. 11,14,15,17 The widespread involvement of the vasculature below the lesion suggests the spread of neuronal impulses intraspinally, resulting in a marked reduction in peripheral blood flow, which may result in cold limbs. 15 As the pressor stimuli below the lesion add sensitivity to the SkARV test, 5 we recommend its association with clinical tests, such as PVS, cystometry, cutaneous cold 18 or electrical stimulation.…”

Section: Discussionmentioning

confidence: 99%

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Assessment of the sympathetic level of lesion in patients with spinal cord injury

Prévinaire

Soler²,

Masri

et al. 2008

Spinal Cord

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Study design: To study the vasomotor responses (skin axon-reflex vasodilatation (SkARV) to stimulation of the skin in spinal cord injury (SCI) patients. Objective: To assess the completeness of the sympathetic injury and to define the sympathetic level of lesion in paraplegic and tetraplegic patients. Setting: Centre Calve, Fondation Hopale and Centre Bouffard-Vercelli, France. Subjects: A total of 81 SCI patients ranging from C2 to L2. Method: A mechanical stimulation was applied to the skin on both sides of the trunk, using a blunt instrument. The presence of an abnormal response below the lesion helped define the sympathetic level. Results: Above the lesion, SkARV was observed in all patients. In patients with a complete sympathetic injury, the response below the lesion was either a vasoconstrictor response in upper motor neuron lesions, or total absence of SkARV in lower motor neuron lesions. There was excellent correspondence between complete somatic (American Spinal Injury Association (ASIA) A) and complete sympathetic lesions (100% of paraplegic and 94% of tetraplegic patients), whereas an incomplete somatic (ASIA B-D) lesion was often associated with a complete sympathetic lesion. In 34% of complete ASIA A patients, a sympathetic zone of partial preservation was found, extending below the lesion on sensory denervated dermatomes. Conclusion: SkARV is a simple bedside test that allows the assessment of sympathetic completeness of injury across the lesion as well as the excitability of the isolated spinal cord. We suggest that the definition of sympathetic level should be part of the classification of complete thoracic SCI.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Assessment of the sympathetic level of lesion in patients with spinal cord injury

Prévinaire

Soler²,

Masri

et al. 2008

Spinal Cord

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“…PUE is thus quite distinct from the so-called RE, which occurs relatively frequently in men with SCI. 4,5 If AE does not occur, RE is defined as any sperm in the urine sample. If AE does occur, various definitions of RE have been proposed, based on the presence of sperm in the postejaculatory urine: sperm count above 5 million, 5-10% content of sperm or 45-10 sperm per high-power field.…”

Section: Discussionmentioning

confidence: 99%

“…This involves catherization to completely empty all urine from the bladder, followed by the instillation of a pink buffering medium (40 ml of Ferticult, Fertipro NV, Belgium) and then PVS. 5,12 If they failed to ejaculate, PVS was combined with oral midodrine, starting with 5 mg and increased in steps of 7.5 mg until the patient ejaculated, up to 30 mg.…”

Section: Methodsmentioning

confidence: 99%

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Evidence of a new pattern of ejaculation in men with spinal cord injury: ejaculation dyssynergia and implications for fertility

Mieusset

2016

Spinal Cord

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Objectives: To describe the presence of sperm in the prostatic urethra as a stand-alone ejaculation entity and to assess its characteristics. Methods: Thirty-three patients with anejaculation during sexual stimulation were enroled. Penile vibratory stimulations were carried out following bladder catherization and instillation of a pink buffering medium (Ferticult). Two-step catheterisation was then performed: a catheter was inserted through the urethral sphincter into the prostatic urethra to aspirate its content, and then bladder catheterisation was performed to collect the Ferticult. The procedure was repeated in some patients after at least 1 week. The characteristics of the semen collected from each organ were analysed and compared. Results: A total of 42 trials were obtained from 22 patients. Sperms were found in the prostatic urethra in 21 samples (50%) from 12 patients (11 with spinal cord injury, 1 with diabetes). The colour of all 21 prostatic urethra sperm samples differed from the Ferticult. Sperm motility was greater in 8 samples, sperm count was higher in 10 and pH was different in 10, compared with the bladder samples. The higher overall quality of the sperm allowed cryopreservation in 10 prostatic urethra samples compared with only 5 bladder samples. Four of the five patients who underwent repeated trials had a reproducible pattern of prostatic urethra ejaculation. Conclusion: The presence of sperm in the prostatic urethra most probably results from 'ejaculation dyssynergia', a lack of coordination between bladder neck and external sphincter. Sperm from the prostatic urethra should be systematically sought to improve the outcome of assisted reproduction.

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Human spinal ejaculation generator

Chéhensse

Facchinetti

Bahrami

et al. 2016

Annals of Neurology

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Midodrine Improves Ejaculation in Spinal Cord Injured Men

Abstract: Midodrine is a safe and efficient adjunct to penile vibratory stimulation for anejaculation in spinal cord injured patients.

Cited by 81 publications

References 18 publications

Assessment of the sympathetic level of lesion in patients with spinal cord injury

Assessment of the sympathetic level of lesion in patients with spinal cord injury

Evidence of a new pattern of ejaculation in men with spinal cord injury: ejaculation dyssynergia and implications for fertility

Human spinal ejaculation generator

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