Sexual and reproductive function in spinal cord injury and spinal surgery patients

doi:10.4081/or.2015.5842

Cited by 20 publications

(14 citation statements)

References 42 publications

(66 reference statements)

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“…22 The etiology of ejaculatory dysfunction, such as DE, after spinal surgery likely involves insult to either of the pathways involved in the 2 phases of ejaculation-emission and expulsion. 23 As both of these processes receive input from the sympathetic and parasympathetic systems, injury to either, which are at risk during surgery around the vertebrae/paravertebral areas, may lead to dysfunction. 24,25 Surgeons should therefore be aware of this risk so that patients may be counseled appropriately prior to these surgeries.…”

Section: Discussionmentioning

confidence: 99%

Delayed Ejaculation After Lumbar Spine Surgery: A Claims Database Analysis

Bhambhvani

Kasman

Zhang

et al. 2020

Global Spine Journal

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Study Design: Retrospective cohort. Objectives: Delayed ejaculation (DE) is a distressing condition characterized by a notable delay in ejaculation or complete inability to achieve ejaculation, and there are no existing reports of DE following lumbar spine surgery. Inspired by our institutional experience, we sought to assess national rates of DE following surgery of the lumbar spine. Methods: We queried the Optum De-identified Clinformatics Database for adult men undergoing surgery of the lumbar spine between 2003 and 2017. The primary outcome was the development of DE within 2 years of surgery. Multivariable logistic regression was performed to identify factors associated with the development of DE. Results: We identified 117 918 men who underwent 162 646 lumbar spine surgeries, including anterior lumbar interbody fusion (ALIF), posterior lumbar fusion (PLF), and more. The overall incidence of DE was 0.09%, with the highest rate among ALIF surgeries at 0.13%. In multivariable analysis, the odds of developing DE did not vary between anterior/lateral lumbar interbody fusion, PLF, and other spine surgeries. A history of tobacco smoking (OR = 1.47, 95% CI 1.00-2.16, P = .05) and obesity (OR = 1.56, 95% CI 1.00-2.44, P = .05) were associated with development of DE. Conclusions: DE is a rare but distressing complication of thoracolumbar spine surgery, and patients should be queried for relevant symptoms at postoperative visits when indicated.

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Section: Discussionmentioning

confidence: 99%

Delayed Ejaculation After Lumbar Spine Surgery: A Claims Database Analysis

Bhambhvani

Kasman

Zhang

et al. 2020

Global Spine Journal

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“…Spinal pathology arising from trauma, deformity, and degenerative disease processes may be harmful to sexual and reproductive function (1).…”

Section: Introductionmentioning

confidence: 99%

Histopathological and Follicular Atresia Assessment of Rat’s Ovarian Tissue Following Experimental Chronic Spinal Cord Injury

Zarbakhsh

Amjad

Yousefi

et al. 2017

Middle East J Rehabil Health

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Background: One of the important side effects in spinal cord injuries in both genders is sexual dysfunction. This study aimed at investigating histopathological changes of ovaries in the chronic phase after spinal cord injury. Methods: Animals (adult female rats) were divided to the following groups, Control (Co), Sham (Sh), and Spinal Cord Injury (SCI); each group contained 18 rats. The spinal cord of SCI animals was transected by the bilateral laminectomy method on level T9, while the rats of the sham group were incised in the same location without any spinal cord injury. Animals were sacrified at 7th, 14th and 21st day postsurgical intervention, then the body weight, and the weight and volume of ovaries were measured. The slices were stained by hematoxylin and eosin and periodic acid Schiff methods. The histomorphometric changes of the diameter of the follicle and ovum, and the thickness of granulosa layer were measured in different kinds of follicles including, Unilaminar Primary Follicle (UPF), Multilaminar Primary Follicle (MPF), Secondary Follicle (SF), and Tertiary Follicle (TF). Results:The results showed that the animal weights were decreased in three SCI groups (P = 0.018). In the SCI groups, the diameter of follicle and ovum and the thickness of granulosa layer were significantly decreased in different kinds of follicles (P = 0.012). Also the thickness of zona pellucida and theca interna were significantly decreased in UPF, SF, and TF in the SCI groups on 14th and 21st day (P = 0.024). The histopathologic examination revealed widespread ovarian follicle atresia in the SCI groups on the 14th and 21st day, including numerous cell debris and inflammatory cells in the antrum atretic follicles. The ovarian stroma showed edema, fibrosis, hypercellularity, and vasodilation in the SCI group, compared to the sham or control groups. Conclusions: The histopathlogic data indicated that after spinal cord injury many histologic parameter changes occurred and hetrogenity of ovarian structure increased. These changes may be caused by dysfunction of the autonomic system and the modification in amount of the ovarian neurotransmiters.

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“…Oncology care has been among the first to urge the need for discussing fertility, initially by running surveys among doctors and patients to expose the lack of discussion about fertility [2,3], later by developing guidelines regarding the options for fertility preservation (FP) and the initiation of this topic in clinical practice, leading to a new field of ''oncofertility'' [4][5][6][7][8]. In spinal care, patients are faced with potential hazards to fertility and reproduction as well [9]. For example, 44 % of all patients with cauda equina syndrome experiences sexual dysfunction (defined as any problem resulting in abnormal intercourse, ranging from, e.g., decreased penile or vaginal sensation to impotence or retrograde ejaculation), displaying that this group is potentially at high risk for in-or sub-fertility [10].…”

Section: Introductionmentioning

confidence: 99%

“…Apart from consequences of the disease itself, surgical treatments might impose an additional risk on fertility, in particular for men. Anterior spinal surgery, especially the transperitoneal approach, may cause damage to the hypogastric plexus and therefore cause retrograde ejaculation [9]. In women, damage to the hypogastric plexus has the potential to reduce pain sensations of the uterus and seems not to affect fertility in that sense.…”

Section: Introductionmentioning

confidence: 99%

Discussing reproductive health in spinal care, part II: fertility issues

et al. 2016

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Purpose Due to advancing insights, discussing fertility in spinal care is an emerging topic. Studies among neurosurgeons to evaluate clinical practice about discussing fertility are non-existent. The aim of this study is to review knowledge, attitude and practice patterns regarding discussing fertility in spinal care. Methods Dutch neurosurgeons and residents were sent a mail-based questionnaire addressing attitude, knowledge and practice patterns regarding discussing fertility. Results Response rate was 62 % (compared to mean of 28 % in similar surveys) with 89 questionnaires suitable for analysis. Mean age was 42 years with 83 % of respondents being male. A quarter of respondents stated neurosurgeons are responsible to discuss fertility, with 12 % indicating to actually do this. Fertility is discussed more often with patients with cauda equina syndrome (70 %) and with men (p = 0.006). Merely 8 % of respondents stated to have adequate knowledge on fertility preservation (FP); this percentage was higher for doctors with spinal surgery as specialty (p = 0.015). In case of cauda equina syndrome, doctors with more knowledge discussed fertility more often (p = 0.002). Fifty-three percent of neurosurgeons wished to enhance their knowledge, in order to feel more comfortable to discuss fertility with their patients.Five percent indicated to have ever referred a patient to a fertility specialist. Conclusion With the exception of cauda equina syndrome, fertility is not routinely discussed in spinal care. Fertility is discussed more often with men. Recent guidelines state that discussing fertility is an essential part of good practice in spinal care. Education on fertility and FP needs to be integrated in the neurosurgical training program to create more awareness, and to enable clinicians to provide adequate information and care to the patient.

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Sexual and reproductive function in spinal cord injury and spinal surgery patients

Cited by 20 publications

References 42 publications

Delayed Ejaculation After Lumbar Spine Surgery: A Claims Database Analysis

Delayed Ejaculation After Lumbar Spine Surgery: A Claims Database Analysis

Histopathological and Follicular Atresia Assessment of Rat’s Ovarian Tissue Following Experimental Chronic Spinal Cord Injury

Discussing reproductive health in spinal care, part II: fertility issues

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