Table 2: Studies Assessing Ejaculation
Sonksen et al., 1994 (31) / 2 prospective trials. / Study 1: 25 SCI M; C3-L1 - 16 C, 9 I; PVS with different Hz & vibratory amplitudes.
Study 2: 41 SCI M; C2-L1 - 28 C, 13 I; PVS with 100 Hz and 2.5 mm amplitude and nifedipine. / Effect on anterograde or retrograde E. / Study 1 output of 100 Hz and 2.5 mm produced increased E rates compared to 1 mm. Study 1 & 2; 88% had E.
Lowest level lesion for anterograde E was T9, and L1 for retrograde E.
No M had BP higher than 200/110. Suggested an “ejaculatory threshold” Recommended all patients try PVS and don’t rule it out. / M with history of AD at >T6 had nifedipine pre-procedure.
With anterograde E continuous abdominal muscle contractions at start of PVS changed to repetitive with E. Leg spasms initially repetitive changed to contiguous. With retrograde E or no E, spasms were more sporadic, less pronounced and didn’t appear on stim. If both abdominal and leg contractions were present E occurred in 46/48 M. / Evaluate E responses to PVS, with varying frequency and amplitude
Ohl et al, 1996 (32) / Case series with PVS [2.5 mm peak to peak amplitude and frequency of 100 Hz]. / 34 SCI M.
9 Cervical,
25 Thoracic [8 = T10 and below]
All underwent PVS. / Ability to achieve E. / 81% above T10 and 12% T10 or lower = anterograde E. With HFR or BCR, 77% E compared to 14% without. Above T10 without penile prosthesis 90% had E, with prosthesis 40% had E / Authors suggested that penile prosthesis may have diminished sensory input, but this hypothesis needs to be verified.
PVS stim parameters became the standard. / To optimize efficacy of PVS to evoke E after SCI
Denys et al, 1998 (33) / Prospective before and after trial. / 9 SCI M who had baclofen pump implanted. 5 C4-T11,
4 Multiple sclerosis. / Effect on libido, E and erection. / Baclofen pump impaired overall erections 8/9; 3 men who were able to E before lost the ability to after. / Only 1 of these were SCI and E returned when the pump was off.
Low N for SCI to evaluate / To examine effect of intrathecal baclofen on sex function in M with SCI or MS
Wieder et al., 2000 (34) / Prospective unblinded trial. Effect of dorsal penile nerve block (with lidocaine) on PVS. / 8 SCI M with BCR and consistent anterograde response to PVS. / Ability to achieve E. / With nerve block 100% had inhibition of anterograde and retrograde E / Ejaculatory response to PVS requires intact dorsal penile nerves / Determine effect of penile block on PVS induced E
Bird et al., 2001 (35) / Retrospective chart review. / Evaluated 123 SCI M and 204 PVS trials to determine predictors of E. / Ability to achieve E. / 80% of M with BCR and HFR had E with PVS; 8% with no BCR and no HR had E. / Cervical SCI should have PVS; T1-T6 with 1 reflex try PVS; T7-T12 with 2 reflexes or only BCR try PVS. Leg movements, spasms and piloerections frequently accompanied E. / Identify if level of injury predicts E success with PVS
Brackett et al.,2007 (36) / Retrospective chart review of men undergoing PVS. 1991-2006. / 297 SCI M who underwent 965 trials of PVS / Ability to achieve E. / 49% of all SCI M & 57% of SCI M with T10 & above responded to PVS with 1 vibrator. 22% of failures with 1 vibrator responded to 2 vibrators. / Authors hypothesized that 2 vibrators work better because of increased stim to dorsal penile nerve. Also noted PVS required an intact ejaculatory reflex arc. / Compare the use of 1 vs 2 simulators to evoke E
Courtois et al, 2007 (37) / Retrospective chart review of M who underwent progressive protocol with PVS +/- midodrine to induce E. / 45/62 SCI M completed the protocols. Most that did not complete trials left because of lack of interest after a few negative tests. / Ability to achieve E, BP and sensations with and without E. / 89% of all who completed the protocol (40/45) achieved E. 96% of C2-8 (18), 89% of T1-T6 (5), 80% of T7-T10 (8), 67% of T11-L2 (12) achieved E. Success rate below L2 was not analyzed as only 2 subjects. / Lower injuries more likely to respond to natural stim, M with cervical injuries more likely to respond to PVS. Difficult to interpret as the different levels of injuries were not broken down to C and I. / E success with PVS +/- midodrine
Courtois et al., 2008 (25) / Prospective assessment of E success using masturbation, PVS +/- midodrine. / 81 SCI M C2-S5; 49% ASIA A, 51% ASIA B-D.
40 T, 15 P T3-T6,
6 P T7-T10,
9 P T11-L2,
11 P below L3. / Ability to achieve E, BP, 2 questionnaires assessing sensation. / 90-93% of M with C2-T6 lesions had E; 100% with T7-10 & L3 below had E, 67% of T11-L2 had E. / Cardiovascular changes were a secondary goal and are listed in Table 3. / E success after self-stimulation, PVS, or PVS+ midodrine in M with various levels of SCI
Giuliano et al.,2008 (38) / DBPC parallel group 12 weeks study of vardenafil vs placebo. / 418 SCI M; 207 vardenafil & 211 placebo entered study.
168 vardenafil & 156 placebo and completed. / IIEF, SE. / Least square mean per E success rates were 19% on vardenafil vs 10% with placebo. Domain increased from 2.9 to 4.0 with vardenafil vs. 3.0 to 3.4 with placebo.
Some increase in O with vardenafil vs placebo. / Vardenafil had slight increased E success in ASIA A group; but ASIA B-D groups observed a significant increase in E with vardenafil vs placebo. / Effect of vardenafil on E and self-confidence in M with SCI
Soler et al., 2007 (39) / Prospective assessment of E with the addition of midodrine. / 158 SCI M that failed to E with PVS in clinical setting were given midodrine + PVS.
118 ASIA A
40 ASIA B-C
137 UMN; 21 LMN. / E and O. / Overall 65% had E. Retrograde E more frequent with LMN compared to UMN. 62% of T, 69% with P above T6; 46% P between T7-T10; and 79% below T11, achieved E / Same population as studied in Table 1 / Ability of midodrine to facilitate E.
Biering-Sorensen, et al. 2012 (40) / Cross sectional questionnaire with retrospective neuro from files. / 187/193 SCI M
answered question on E. / Local questionnaire / 87 (46%) no E; 82 (44%) reported E with 56% of these using aids for E;
18 (10%) not tried. / Study did not include a question about O so unable to compare with other studies. / Assess sex function and satisfaction in M >10yrs after SCI
Table 2: Studies assessing ejaculation