Midodrine in patients with spinal cord injury and anejaculation: A double-blind randomized placebo-controlled pilot study

Leduc, Bernard; Fournier, Christine; Jacquemin, G.; Lepage, Yves; Vinet, Bernard; Hétu, Pierre-Olivier; Chagnon, Miguel

doi:10.1179/2045772314y.0000000225

Cited by 14 publications

(5 citation statements)

References 16 publications

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“…which is a noncatecholamine, sympathomimetic amine) 2 hours prior to masturbation in a patient with neurogenic AE [ 92 ]. In contrast, a recent double-blind randomized placebo-controlled small study [ 94 ] showed that midodrine was similar to placebo in inducing antegrade ejaculation in patients with SCI. For patients who suffer from antidepressant-related DE/AE, shifting to another antidepressant such as bupropion or adding cabergoline if they have hyperprolactinemia may be the most prudent option.…”

Section: Treatmentmentioning

confidence: 96%

Delayed Ejaculation: Pathophysiology, Diagnosis, and Treatment

Abdel‐Hamid

Ali

2018

World J Mens Health

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Delayed ejaculation (DE) is a poorly defined and uncommon form of male sexual dysfunction, characterized by a marked delay in ejaculation or an inability to achieve ejaculation. It is often quite concerning to patients and their partners, and sometimes frustrates couples' attempts to conceive. This article aims to review the pathophysiology of DE and anejaculation (AE), to explore our current understanding of the diagnosis, and to present the treatment options for this condition. Electronic databases were searched from 1966 to October 2017, including PubMed (MEDLINE) and Embase. We combined “delayed ejaculation,” “retarded ejaculation,” “inhibited ejaculation,” or “anejaculation” as Medical Subject Headings (MeSH) terms or keywords with “epidemiology,” “etiology,” “pathophysiology,” “clinical assessment,” “diagnosis,” or “treatment.” Relevant sexual medicine textbooks were searched as well. The literature suggests that the pathophysiology of DE/AE is multifactorial, including both organic and psychosocial factors. Despite the many publications on this condition, the exact pathogenesis is not yet known. There is currently no single gold standard for diagnosing DE/AE, as operationalized criteria do not exist. The history is the key to the diagnosis. Treatment should be cause-specific. There are many approaches to treatment planning, including various psychological interventions, pharmacotherapy, and specific treatments for infertile men. An approved form of drug therapy does not exist. A number of approaches can be employed for infertile men, including the collection of nocturnal emissions, prostatic massage, prostatic urethra catheterization, penile vibratory stimulation, probe electroejaculation, sperm retrieval by aspiration from either the vas deferens or the epididymis, and testicular sperm extraction.

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Section: Treatmentmentioning

confidence: 96%

Delayed Ejaculation: Pathophysiology, Diagnosis, and Treatment

Abdel‐Hamid

Ali

2018

World J Mens Health

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“…The drug was well‐tolerated (Soler et al ., ; Courtois et al ., ). In contrast, a recent double‐blind, randomized, placebo‐controlled study found no improvement in ejaculation success rates by PVS combined with midodrine vs. a placebo (Leduc et al ., ). These findings indicate that midodrine in combination with PVS may be considered prior to attempting EEJ, but further investigation is needed before midodrine is recommended in all cases of PVS failure.…”

Section: Ejaculatory Dysfunction In Men With Scimentioning

confidence: 97%

Male fertility following spinal cord injury: an update

2015

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SUMMARYSpinal cord injury (SCI) occurs most often in young men at the peak of their reproductive health. The majority of men with SCI cannot father children naturally. Three major complications contribute to infertility in men with SCI: erectile dysfunction, ejaculatory dysfunction, and abnormal semen quality. Erectile dysfunction can be managed by regimens available to the general population, including oral administration of phosphodiesterase-5 (PDE-5) inhibitors, intracavernosal injections, vacuum devices, and penile prostheses. Semen may be obtained from anejaculatory men with SCI via the medically assisted ejaculation methods of penile vibratory stimulation (PVS) or electroejaculation (EEJ). Sperm retrieval is also possible via prostate massage or surgical sperm retrieval. Most men with SCI have abnormal semen quality characterized by normal sperm concentrations but abnormally low sperm motility and viability. Accessory gland dysfunction has been proposed as the cause of these abnormalities. Leukocytospermia is evident in most SCI patients. Additionally, elevated concentrations of pro-inflammatory cytokines and elevated concentrations of inflammasome components are found in their semen. Neutralization of these constituents has resulted in improved sperm motility. There is a recent and alarming trend in the management of infertility in couples with SCI male partners. Although many men with SCI have sufficient motile sperm in their ejaculates for attempting intrauterine insemination (IUI) or even intravaginal insemination, surgical sperm retrieval is often introduced as the first and only sperm retrieval method for these couples. Surgical sperm retrieval commits the couple to the most advanced, expensive, and invasive method of assisted conception: in vitro fertilization with intracytoplasmic sperm injection (IVF/ICSI). Couples should be informed of all options, including semen retrieval by PVS or EEJ. Intravaginal insemination or IUI should be considered when indicated.

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“…The following therapies, administered simultaneously with PVS, have each been shown to rescue failures to PVS alone: abdominal electrical stimulation; 37 PDE-5 inhibitors; 38 39 and midodrine. 40 41 42 …”

Section: Sequelae Of Sci That Affect Male Fertilitymentioning

confidence: 99%

Advances in the management of infertility in men with spinal cord injury

2016

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Couples with a spinal cord injured male partner require assisted ejaculation techniques to collect semen that can then be further used in various assisted reproductive technology methods to achieve a pregnancy. The majority of men sustaining a spinal cord injury regardless of the cause or the level of injury cannot ejaculate during sexual intercourse. Only a small minority can ejaculate by masturbation. Penile vibratory stimulation and electroejaculation are the two most common methods used to retrieve sperm. Other techniques such as prostatic massage and the adjunct application of other medications can be used, but the results are inconsistent. Surgical sperm retrieval should be considered as a last resort if all other methods fail. Special attention must be paid to patients with T6 and rostral levels of injury due to the risk of autonomic dysreflexia resulting from stimulation below the level of injury. Bladder preparation should be performed before stimulation if retrograde ejaculation is anticipated. Erectile dysfunction is ubiquitous in the spinal cord injured population but is usually easily managed and does not pose a barrier to semen retrieval in these men. Semen analysis parameters of men with spinal cord injury are unique for this population regardless of the method of retrieval, generally presenting as normal sperm concentration but abnormally low sperm motility and viability. When sperm retrieval is desired in this population, emphasis should be placed on initially trying the simple methods of penile vibratory stimulation or electroejaculation before resorting to more advanced and invasive surgical procedures.

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Midodrine in patients with spinal cord injury and anejaculation: A double-blind randomized placebo-controlled pilot study

Cited by 14 publications

References 16 publications

Delayed Ejaculation: Pathophysiology, Diagnosis, and Treatment

Delayed Ejaculation: Pathophysiology, Diagnosis, and Treatment

Male fertility following spinal cord injury: an update

Advances in the management of infertility in men with spinal cord injury

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