A GUIDE AND RESOURCE DIRECTORY TO MALE FERTILITY FOLLOWING SPINAL CORD INJURY/DYSFUNCTION
Maria J. Amador, BSN, CRRN; Charles M. Lynne, MD; Nancy L. Brackett, PhD., HCLD
Published by the Miami Project to Cure Paralysis, University of Miami School of Medicine
A publication funded by the Paralyzed Veterans of America Spinal Cord Injury Education and Training Foundation
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The Journal of Urology
Volume 159(6) June 1998 pp 1931-1934
AN ANALYSIS OF 653 TRIALS OF PENILE VIBRATORY STIMULATION IN MEN WITH SPINAL CORD INJURY
Brackett, Nancy L.; Ferrell, Sean M.; Aballa, Teodoro C.; Amador, Maria J.; Padron, Osvaldo F.; Sonksen, Jens; Lynne Charles
ABSTRACT
Purpose: We evaluated ejaculatory response and semen quality in 653 trials of penil vibratory stimulation in 211 men with spinal cord injury, and compared results with low versus high amplitude vibratory stimulation.
Materials and Methods: Low and/or high amplitude penile vibratory stimulation was performed 1 to 27 times in each patient, and antegrade and retrograde specimens of those who ejaculated were analyzed.
Results: Significantly more patients ejaculated using high (54.5%) versus low (39.9%) amplitude stimulation. Using either amplitude the ejaculatory success rate was highest in men with injuries at C3 to C7, followed by T1 to T5, T6 to T10 and T11 to L3. While high amplitude stimulation increased the ejaculatory success rate in each group, the highest rate occurred in men with injuries at C3 to C7 (65.6%). Ejaculation was reliable, since most men who ejaculated did so during the 100% of the trials and within 2 minutes of stimulation onset. Symptoms of autonomic dysreflexia were safely managed with nifedipine. All patients who ejaculated produced antegrade specimens. With the exception of ejaculate volume, which was significantly higher with high versus low amplitude stimulation, semen parameters were similar using both vibrator amplitudes.
Conclusions: Ejaculatory success is better while semen quality is similar using high versus low amplitude penile vibratory stimulation in men with spinal cord injury. This method may be considered first line treatment for anejaculation in men with spinal cord injury. This method may be relatively effective, and relatively low investment of time and money.
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Arch Phys Med Rehabil
Vol. 85, June 2004
ANTISPASTIC EFFECT OF PENILE VIBRATION IN MEN WITH SPINAL CORD LESION
Line Laesoe, MD; Jens Bo Nielsen; Fin Biering-Sorensen, MD; Jens Sonksen, MD
ABSTRACT
Objective: To evaluate the possible antispastic effect of penile vibratory stimulation (PVS) in men with spinal cord lesion (SCL).
Design: Unblinded, before-after trial.
Setting: Ambulatory Care.
Participants: Nine men with SCLs from C2 to T8 were randomly allocated into 2 groups.
Intervention: Twenty-four hours of electromyographic recordings from the quadriceps and tibialis anterior muscles were taken, followed by PVS or no treatment and another 24 hours of electromyographic recordings. The presence of electromyographic activity of an amplitude 4 times the baseline, with a duration of more than 5 seconds, was taken to signify a spasm. The number of spasms per hour was calculated before and after PVS and no treatment. Spasticity was evaluated by the Modified Ashworth Scale (MAS).
Main Outcome Measure: Reduction in spasticity and spasms.
Results: The electromyographic data showed a significant reduction in the frequency of leg spasms up to 3 hours (P<.05). Significantly decreased spasticity, as evaluated by MAS, was found immediately after vibration (P<.01).
Conclusions: PVS may be useful as an antispastic therapy.
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The Journal of Urology
Vol. 169, 2210-2215, June 2003
URODYNAMIC EFFECT OF ACUTE TRANSCUTANEOUS POSTERIOR TIBIAL NERVE STIMULATION IN OVERACTIVE BLADDER
G. Amarenco; S. Sheikh Ismael; A. Even-Schneider; P. Raibaut; S. Demaille-Wlodyka; B. Parratte; J. Kerdraon
ABSTRACT
Purpose: Of the various treatments proposed for urge incontinence, frequency and urgency electrostimulation has been widely tested. Different techniques have been used with the necessity of surgical implantation (S3 neuromodulation or sacral root stimulation) or without requiring surgery (perineal transcutaneous electrostimulation). Recently peripheral electrical stimulation of the posterior tibial nerve was proposed for irritative symptoms in first intention or for intractable incontinence. Clinical studies have demonstrated good results and urodynamic parameters were improved after chronic treatment. However, to our knowledge no data concerning acute stimulation and immediate cystometry modifications have been reported. We verified urodynamic changes during acute posterior tibial nerve stimulation.
Materials and Methods: A total of 44 consecutive patients with urge incontinence, frequency and urgency secondary to overactive bladder were studied. There were 29 women and 15 men with a mean age + SD of 53.3 + 18.2 years. Of the patients 37 had detrusor hyperrelfexia due to multiple sclerosis (13), spinal cord injury (15) or Parkinson's disease (9), and 7 had idiopathic detrusor instability. Routine cystometry at 50 ml. per minute was done to select the patients with involuntary detrusor contractions appearing before 400 ml. maximum filling volume. Repeat cystometry was performed immediately after the first study during left posterior tibial nerve stimulation using a surface self-adhesive electrode on the ankle skin behind the internal malleolus with shocks in continuous mode at 10Hz. frequency and 200 milliseconds wide. Volume comparison was done at the first involuntary detrusor contraction and a maximum cystometric capacity. The test was considered positive if volume at the first involuntary detrusor contraction and/or at maximum cystometric capacity increased 100 ml. or 50% during stimulation in compared with standard cystometry volumes.
Results: Mean first involuntary detrusor contraction volume on standard cystometry was 162.9 + 96.4 ml. and it was 232.1 + 115.3 ml. during posterior tibial nerve stimulation. Mean maximum cystometric capacity on standard cystometry was 221 + 129.5 ml. and it was 277.4 + 117.9 ml. during stimulation. Posterior tibial nerve stimulation was associated with significant improvement in first involuntary detrusor contraction volume (p<0.0001) and significant improvement in maximum cystometric capacity (p<0.0001). The test was considered positive in 22 of the 44 patients.
Conclusions: These results suggest an objective acute effect of posterior tibial nerve stimulation on urodynamic parameters. Improved bladder overactivity is an encouraging argument to propose posterior tibial nerve stimulation as a noninvasive treatment modality in clinical practice.
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