Partial Ejaculatory Incompetence: the Therapeutic Effect of Midodrine1, an
Orally Active Selective Alpha-Adrenoceptor Agonist

Riley, Alan; Riley, Elizabeth J.

doi:10.1159/000473504

Cited by 47 publications

(19 citation statements)

References 6 publications

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“…ephedrine, are too powerful for fertility tests, so that current pharmacotherapy is left with a gap that might be filled with midodrine. Reports from European clinics suggest successful results in various populations [19][20][21][22][23], including men with SCI [16][17][18], in treating anejaculation, increasing the sperm count in oligospermia, and converting retrograde ejaculation into antegrade ejaculation (although with some contradictory findings). While no severe sideeffects have been reported, those reported appear limited to tingling, hot flushes and spasms [16] (at least at dosages of 5-20 mg) with small increments in BP.…”

Section: Discussionmentioning

confidence: 99%

Blood pressure changes during sexual stimulation, ejaculation and midodrine treatment in men with spinal cord injury

et al. 2007

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pressure (BP) changes measured at baseline and at ejaculation (or on the last trial if the test was negative). Reported sensations were also recorded and compared during positive and negative tests. RESULTSOverall, 89% of the patients reached ejaculation with one mode or another of stimulation. When patients had a negative result with natural stimulation, 56% were salvaged by PVS, and when PVS was negative, another 22% were salvaged by midodrine combined with PVS. The mean systolic BP increased by 35 mmHg at ejaculation during PVS and by 11 mmHg after midodrine, and a subsequent 29 mmHg at ejaculation during PVS combined with midodrine. By contrast, negative tests showed a relatively stable BP; the difference in changes in BP during positive and negative tests was significant ( P < 0.01). Increases in BP during positive tests declined significantly more often within the limits of autonomic dysreflexia than negative tests ( P < 0.01).Study Type -Therapy (case series) Level of Evidence 4 OBJECTIVESTo explore the effectiveness of various sources of self-stimulation, including oral midodrine, in triggering ejaculation in men with spinal cord injury (SCI), and to document the systematic variations in blood pressure at ejaculation and consider a revised definition of autonomic dysreflexia. PATIENTS AND METHODSThe study included 62 men with SCI lesions from C2 to L2. Ejaculation potential was assessed with various sources of stimulation, beginning with natural stimulation, followed, if the test was negative, by penile vibrator stimulation (PVS) followed, if the test was again negative, by PVS combined with oral midodrine, started at 5 mg and increased in 5 mg steps up to 25 mg. The success rate of ejaculation was recorded, as were blood

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Section: Discussionmentioning

confidence: 99%

Blood pressure changes during sexual stimulation, ejaculation and midodrine treatment in men with spinal cord injury

et al. 2007

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“…Lorsque l'appareil de vibromassage -qui est facile à manier pour la plupart des patients, même certains tétraplégiques ayant une dextérité minimale -est inefficace, il peut être complété par une prescription de midodrine, commercialisé sous le nom de Gutron ® , une molécule alphastimulante qui s'est montrée efficace dans le traitement de l'anéjaculation et l'éjaculation rétrograde [26][27][28][29][30][31][32][33][34].…”

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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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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“…With regard to DA agonists, none has been tested in Tx animals, although D2-like agonists injected i.c.v. were reported to promote ejaculation in intact rats (Riley and Riley, 1982;Camacho et al, 2007;Yonezawa et al, 2008).…”

Section: Ejaculationmentioning

confidence: 97%

“…This drug or its shorter-acting version physostigmine, tested a few years later, is no longer utilized because of severe side effects, including autonomic dysreflexia and death (Guttmann, 1971;Jesionowska and Hemmings, 1991;Biering-Sorensen and Sonksen, 2001). Midodrine (an alpha-1 agonist) was also shown to induce either normal (anterograde, i.e., outside the urethral meatus) or abnormal (retrograde, i.e., back inside into the bladder) ejaculation in patients with SCI, but, as with cholinesterase inhibitors, it was also found to increase blood pressure and autonomic dysreflexia (Jonas et al, 1979;Riley and Riley, 1982;Staerman and al., 2001;Blanchard-Dauphin et al, 2005;Garcia-Bravo et al, 2006;Courtois et al, 2008).…”

Section: Ejaculationmentioning

confidence: 99%

“…was found to promote erection and sometimes ejaculation in sensory-stimulated Tx rats (i.e., penile sheath retraction known as the ''penile reflex'' model; Duran et al, 2000;Vargas et al, 2004). Alpha-1 agonists such as methoxamine (which, unlike midodrine, crosses the BBB) were reported to promote reflexively induced ejaculation (either immediately after Tx or by urethral stimulation with fluid injection) in freely moving Tx rats (Riley and Riley, 1982). P-chloroamphetamine (an amphetamine derivative that increases 5-HT release) was repoted to elicit fictive ejaculation (EMG correlates) in anesthetized Tx rats (Pomerantz et al, 1993).…”

Section: Ejaculationmentioning

confidence: 99%

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Key central pattern generators of the spinal cord

Guertin

Steuer

2009

J of Neuroscience Research

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In the central nervous system (CNS), central pattern generators (CPGs) are generally considered as specialized networks that can produce oscillatory motor output in the absence of any oscillatory input. For instance, respiration and mastication are among the critical biological functions well known to be controlled by such specialized networks. Several other CPGs have also been found specifically in the spinal cord. Among them, the CPG for locomotion is probably the most extensively studied rhythm- and pattern-generating network of the CNS. Other, less completely understood CPGs have also been associated with the control of scratching, micturition, and ejaculation. This review provides a brief update on CPG organization and function in the spinal cord and focuses on similarities and differences between these networks and their pharmacological modulation.

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Partial Ejaculatory Incompetence: the Therapeutic Effect of Midodrine1, an Orally Active Selective Alpha-Adrenoceptor Agonist

Cited by 47 publications

References 6 publications

Blood pressure changes during sexual stimulation, ejaculation and midodrine treatment in men with spinal cord injury

Blood pressure changes during sexual stimulation, ejaculation and midodrine treatment in men with spinal cord injury

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

Key central pattern generators of the spinal cord

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