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A Systematic Review of Penile Prosthesis Insertion in Patients With Spinal Cord Injury. Sex Med Rev 2022; 10:468-477. [PMID: 35221231 DOI: 10.1016/j.sxmr.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION A penile prosthesis (PP) may be inserted for erectile dysfunction (ED) and/or urinary management in men with spinal cord injury (SCI). This group of patients is considered high risk for complications due to their reduced mobility and sensation. OBJECTIVES To identify the complication and satisfaction rates following PP insertion in patients with SCI. METHODS A systematic review of the literature was performed according to the PRISMA checklist. The Medline/PubMed and EMBASE databases were searched up to July 27th 2021. Studies on men ≥18 years who had a PP inserted for ED secondary to SCI were included. Two reviewers independently screened all articles, assessed for risk of bias and performed data extraction. RESULTS Eleven studies including 475 men with SCI were included for analysis. The overall complication rate was 4.2-61.1%. Specific complications included infection, 0-16%; erosion, 3.7-11.1% and mechanical failure, 0-16.7%. The explantation rate was 2.1-16.7% and the revision rate was 2.7-44.4%. Overall, 79.2-92.9% of men were satisfied with their PP and, 36-86.1% were having satisfactory sexual intercourse. In those who used the PP for urinary management ± ED, 86.5--92.8%% were satisfied. Men with SCI had higher rates of complications compared to those without SCI (infection, 2.1-9.1% vs non-SCI, 0.8-5.7%; erosion, 2.1-8.3% vs non-SCI, 0%; explanation, 2.1-8.3% vs non-SCI, 0.8-5.7%). CONCLUSION PP is an option for SCI patients for the management of end-stage ED or urinary function, but the rate of infection, erosion and implant explantation is higher compared with men without SCI. Inflatable penile prosthesis (IPP) is the preferred PP due to the lower risk of erosion, however, they are prone to mechanical failure and require good hand dexterity. A thorough pre-operative counselling is essential. Pang KH, Muneer A, Alnajjar HM, et al. A Systematic Review of Penile Prosthesis Insertion in Patients With Spinal Cord Injury. Sex Med Rev 2022;10:461-470.
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Male Sexual Dysfunction and Infertility in Spinal Cord Injury Patients: State-of-the-Art and Future Perspectives. J Pers Med 2022; 12:jpm12060873. [PMID: 35743658 PMCID: PMC9225464 DOI: 10.3390/jpm12060873] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/16/2022] [Accepted: 05/24/2022] [Indexed: 01/27/2023] Open
Abstract
Spinal cord injury (SCI) is a relevant medical and social problem. According to the World Health Organization, the commonly estimated worldwide annual incidence of SCI is 40 to 80 cases per million population. After the SCI experience, most men present with sexual dysfunction (erectile dysfunction (ED) and ejaculatory dysfunction), fertility problems (such as impaired spermatogenesis, abnormalities in sperm viability, motility, and morphology), and systemic disorders such as genitourinary infection and endocrine imbalances. The best options available for managing the ejaculatory disorders in patients suffering from SCI are penile vibratory stimulation (PVS) and electroejaculation (EEJ). Furthermore, the treatment of ED in SCI patients consists of medical therapies including phosphodiesterase 5 inhibitors (PDE5i), intracavernosal injections (ICI), vacuum erection devices (VEDs), and surgical as penile prosthesis (PP). This review provides a snapshot of the current evidence for the mechanisms of sexual dysfunction and infertility in SCI patients, discusses the best management strategies for these conditions, and offers our perspective on the direction of future research.
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Moussa M, Papatsoris AG, Abou Chakra M, Dabboucy B, Fares Y. Erectile dysfunction in common neurological conditions: A narrative review. ACTA ACUST UNITED AC 2020; 92. [PMID: 33348971 DOI: 10.4081/aiua.2020.4.371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/08/2020] [Indexed: 11/23/2022]
Abstract
Neurogenic erectile dysfunction (NED) can be defined as the inability to achieve or maintain an erection due to central or peripheral neurologic disease. Neurologic diseases can also affect the physical ability and psychological status of the patient. All these factors may lead to a primary or secondary NED. Medication history plays an important role since there are many drugs commonly used in neurologic patients that can lead to ED. The assessment of NED in these patients is generally evolving with the application of evoked potentials technology in the test of somatic and autonomic nerves, and functional magnetic resonance imaging. With the electrophysiological examinations, neurogenic causes can be determined. These tools allow to categorize neurologic lesion and assess the patient prognosis. The first-line treatment for NED is phosphodiesterase inhibitors. Second-line treatments include intracavernous and intraurethral vasoactive injections. Third-line treatments are penile prostheses. The efficacy and safety of each treatment modality depend on the specific neurologic condition. This review discusses the physiology, pathophysiology, diagnosis, and treatment of ED in multiple peripheral and central neurologic conditions, as well as for future research.
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Affiliation(s)
- Mohamad Moussa
- Urology Department, Zahraa Hospital, University Medical Center, Beirut.
| | - Athanasios G Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens.
| | - Mohamad Abou Chakra
- Department of Urology, Faculty of Medical Sciences, Lebanese University, Beirut.
| | - Baraa Dabboucy
- Department of Neurosurgery, Faculty of Medical Sciences, Lebanese University, Beirut.
| | - Youssef Fares
- Department of Neurosurgery, Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut.
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Abstract
With the onset of a metabolic syndrome epidemic and the increasing life expectancy, erectile dysfunction (ED) has become a more common condition. As incidence and prevalence increase, the medical field is focused on providing more appropriate therapies. It is common knowledge that ED is a chronic condition that is also associated with a myriad of other disorders. Conditions such as aging, diabetes mellitus, hypertension, obesity, prostatic hypertrophy, and prostate cancer, among others, have a direct implication on the onset and progression of ED. Characterization and recognition of risk factors may help clinicians recognize and properly treat patients suffering from ED. One of the most reliable treatments for ED is penile prosthetic surgery. Since the introduction of the penile prosthesis (PP) in the early seventies, this surgical procedure has improved the lives of thousands of men, with reliable and satisfactory results. The aim of this review article is to characterize the epidemiology of men undergoing penile prosthetic surgery, with a discussion about the most common conditions involved in the development of ED, and that ultimately drive patients into electing to undergo PP placement.
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Affiliation(s)
- Jose A Saavedra-Belaunde
- Department of Surgery/Division of Urology, University of Texas Medical Science Center at Houston, Houston, TX 77030, USA
| | | | - Run Wang
- Department of Surgery/Division of Urology, University of Texas Medical Science Center at Houston, Houston, TX 77030, USA
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Martins-Macedo J, Lepore AC, Domingues HS, Salgado AJ, Gomes ED, Pinto L. Glial restricted precursor cells in central nervous system disorders: Current applications and future perspectives. Glia 2020; 69:513-531. [PMID: 33052610 DOI: 10.1002/glia.23922] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/01/2020] [Accepted: 10/02/2020] [Indexed: 12/27/2022]
Abstract
The crosstalk between glial cells and neurons represents an exceptional feature for maintaining the normal function of the central nervous system (CNS). Increasing evidence has revealed the importance of glial progenitor cells in adult neurogenesis, reestablishment of cellular pools, neuroregeneration, and axonal (re)myelination. Several types of glial progenitors have been described, as well as their potentialities for recovering the CNS from certain traumas or pathologies. Among these precursors, glial-restricted precursor cells (GRPs) are considered the earliest glial progenitors and exhibit tripotency for both Type I/II astrocytes and oligodendrocytes. GRPs have been derived from embryos and embryonic stem cells in animal models and have maintained their capacity for self-renewal. Despite the relatively limited knowledge regarding the isolation, characterization, and function of these progenitors, GRPs are promising candidates for transplantation therapy and reestablishment/repair of CNS functions in neurodegenerative and neuropsychiatric disorders, as well as in traumatic injuries. Herein, we review the definition, isolation, characterization and potentialities of GRPs as cell-based therapies in different neurological conditions. We briefly discuss the implications of using GRPs in CNS regenerative medicine and their possible application in a clinical setting. MAIN POINTS: GRPs are progenitors present in the CNS with differentiation potential restricted to the glial lineage. These cells have been employed in the treatment of a myriad of neurodegenerative and traumatic pathologies, accompanied by promising results, herein reviewed.
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Affiliation(s)
- Joana Martins-Macedo
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Angelo C Lepore
- Department of Neuroscience, Vickie and Jack Farber Institute for Neuroscience, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Helena S Domingues
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - António J Salgado
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Eduardo D Gomes
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Luísa Pinto
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
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Improving Sexual Function by Using Focal Vibrations in Men with Spinal Cord Injury: Encouraging Findings from a Feasibility Study. J Clin Med 2019; 8:jcm8050658. [PMID: 31083543 PMCID: PMC6571747 DOI: 10.3390/jcm8050658] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 05/08/2019] [Accepted: 05/10/2019] [Indexed: 12/18/2022] Open
Abstract
Erectile dysfunction (ED) is a frequent and disabling condition in patients with spinal cord injury (SCI). Spasticity can negatively affect sexual intercourse, as it may interfere with positioning, mobility, and muscle activation and strength, leading to ED. The aim of our study was to evaluate the feasibility and efficacy of muscle vibration (MV) applied to the pelvic muscles in improving ED in men with SCI. Ten adult men with traumatic SCI were submitted to 15 sessions of MV, applied on the perineum and the suprapubic and sacrococcygeal areas, using a pneumatic vibrator. MV was performed three times a week for five consecutive weeks, each session lasting 30 min. Muscle tone and sexual function were assessed before and after MV using the Modified Ashworth Scale (MAS) and International Index of Erectile Function (IIEF). We assessed the cremasteric and bulbocavernosus reflexes, as well as the electrophysiological bulbocavernosus reflex (eBCR) and pudendal nerve somatosensory-evoked potential (PSEP). MV was safe and well tolerated. All the patients reported an improvement in MAS and IIEF, with better reflexive responses, and a significant increase in eBCR and PSEP amplitude. In conclusion, MV of the pelvic floor is a promising method to reduce segmental spasticity and improve ED in men with incomplete SCI. However, our findings require confirmation through a randomized clinical trial with a larger sample size and longer trial period to examine long-term after effects.
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A randomized double-blind, placebo-controlled, cross-over trial assessing the effect of tadalafil (Cialis) on the cardiovascular response in men with complete spinal cord injury above the sixth thoracic level: A Pilot Study. Spinal Cord Ser Cases 2018; 4:105. [PMID: 30479838 PMCID: PMC6249218 DOI: 10.1038/s41394-018-0137-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 07/09/2018] [Accepted: 11/01/2018] [Indexed: 12/02/2022] Open
Abstract
Study design Double-blind, randomized cross-over placebo-controlled pilot study. Objectives To determine the effects of tadalafil on systolic blood pressure (SBP), heart rate (HR), and dizziness of men with American Spinal Injury Association Impairment Scale-A (AIS-A) spinal cord injury (SCI) between cervical-4 (C4) and thoracic-5 (T5) levels. Setting Outpatient rehabilitation clinic. Design Double-blind, randomized cross-over placebo-controlled pilot study. Methods 20 males with AIS-A SCI, C4-T5 received either tadalafil 20 mg or placebo for the first arm, and then were crossed-over after 1 week to the second arm. SBP, HR, and Visual Analogue Scale (VAS) for dizziness upon sitting up from lying were measured at baseline and again 1, 2, 4, 12, 22, 29, and 36 h post dose administration. The change in each outcome measure (SBP, HR, VAS dizziness) was observed from pre-dose to each time point. A change in VAS dizziness of 2 cm or greater (scale 0–10 cm) was considered positive. Results SBP did not change significantly in either group. However, HR increased significantly in the tadalafil group at several time points (12 h p < 0.05, 22 h p <0.05, 29 h p <0.01, and 36 h p <0.05), with no change in the placebo group. The VAS dizziness significantly increased (range 2–6 cm changes) at some time point in 1/4 of the subjects after tadalafil, but not in the placebo group; all reports of dizziness were at 12 h or later. Conclusions Tadalafil use in people with SCI above T6 is safe with respect to not causing hypotension; hemodynamic changes that occurred 12–36 h post administration were compensated for by elevations in HR. Sponsorship The Manitoba Medical Services Foundation and the Health Sciences Centre Foundation.
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Silva JM, Chavarriaga Soto J, Orrego PA, Iregui Parra JD, Álvarez Villaraga D, Godoy MP. Función eréctil y salud sexual en hombres con trauma raquimedular: estudio transversal. Rev Urol 2017. [DOI: 10.1016/j.uroco.2016.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Morrison BF, White-Gittens I, Smith S, St John S, Bent R, Dixon R. Evaluation of sexual and fertility dysfunction in spinal cord-injured men in Jamaica. Spinal Cord Ser Cases 2017; 3:17026. [PMID: 28584661 DOI: 10.1038/scsandc.2017.26] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/14/2017] [Accepted: 04/08/2017] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Sexual dysfunction and infertility are common in males with traumatic spinal cord injuries (SCIs). The objective of this study was to determine the prevalence of sexual dysfunction and infertility in males with traumatic SCI managed in Jamaica, as well as the therapeutic options offered. CASE PRESENTATION A cross-sectional study including males with traumatic SCI managed at the Sir John Golding Rehabilitation Centre, Kingston, Jamaica was carried out between 1 January and 31 December 2015. Sexual function was measured with the International Index of Erectile Function Questionnaire, and further information on social history, fertility desires and treatment options offered were collected. Data were analyzed using Stata 12 for Windows (College Station, TX, USA). The mean age of patients at the time of study was 38.8±15.3 years (range 19-71) with a mean duration of injury of 3.7±2.4 years (range 1.3-15.6). Of 45 patients with traumatic SCI surveyed, 90.7% had erectile dysfunction, with 62.8% being classified as severe and 73.3% of men were unable to ejaculate. Treatment for erectile and ejaculatory dysfunction was offered in only two patients, respectively. Most (71.1%) patients indicated that they wanted to have children in the future, however, no one had been referred for assisted reproductive techniques. DISCUSSION Men with traumatic SCI have high rates of severe erectile and ejaculatory dysfunctions, but have preserved interests in maintaining fertility. Adherence to guidelines for sexual education for men with traumatic SCI in Jamaica and the Caribbean is needed.
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Affiliation(s)
| | | | - Simon Smith
- Sir John Golding Rehabilitation Centre, Kingston, Jamaica
| | - Shari St John
- Sir John Golding Rehabilitation Centre, Kingston, Jamaica
| | - Romar Bent
- Sir John Golding Rehabilitation Centre, Kingston, Jamaica
| | - Rory Dixon
- Sir John Golding Rehabilitation Centre, Kingston, Jamaica
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Pakpour AH, Rahnama P, Saberi H, Saffari M, Rahimi-movaghar V, Burri A, Hajiaghababaei M. The relationship between anxiety, depression and religious coping strategies and erectile dysfunction in Iranian patients with spinal cord injury. Spinal Cord 2016; 54:1053-1057. [DOI: 10.1038/sc.2016.7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 12/16/2015] [Accepted: 01/05/2016] [Indexed: 11/09/2022]
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Torrecilha LA, Costa BT, Lima FB, Santos SMS, Souza RBD. O perfil da sexualidade em homens com lesão medular. FISIOTERAPIA EM MOVIMENTO 2014. [DOI: 10.1590/0103-5150.027.001.ao04] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Introdução Entre as consequências da lesão medular (LM), está o deficit na função sexual, o que interfere na qualidade de vida do indivíduo. Objetivos Conhecer e descrever o perfil da sexualidade de homens com LM, comparando os períodos pré e pós-lesão. Materiais e métodos Estudo transversal com 36 homens com LM. Os dados foram coletados através de um questionário (QSH-LM) e um roteiro. As variáveis quantitativas foram apresentadas por média e desvio padrão. As variáveis categóricas foram apresentadas por frequências absolutas e relativas e as associações foram realizadas através do teste Qui-quadrado. Todos os testes apresentaram significância de 5%. Resultados Houve prevalência de pacientes paraplégicos e de lesões do tipo completa. A prática, frequência, desejo e satisfação sexual decaíram após a LM, assim como as respostas sexuais. Dentre essas estão ereção, ejaculação e orgasmo, que decaíram de forma relevante após a LM. A sensação mais relatada durante o ato sexual foi o aumento da resposta cardiorrespiratória, antes ou após a LM, e mais indivíduos passaram a sentir nenhuma sensação durante a atividade sexual após a LM. Houve significativa associação entre tipo de lesão e presença de orgasmo e entre prática e satisfação sexual após a LM. Conclusão Foi observado que a resposta sexual após a LM altera na ordem crescente: ereção, orgasmo e ejaculação. Percebe-se que muitas vezes a reabilitação é focada nas capacidades motoras e a sexualidade é pouco abordada.
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Hess MJ, Hough S. Impact of spinal cord injury on sexuality: broad-based clinical practice intervention and practical application. J Spinal Cord Med 2012; 35:211-8. [PMID: 22925747 PMCID: PMC3425877 DOI: 10.1179/2045772312y.0000000025] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
This study focuses on the impact a spinal cord injury may have on achieving physical and emotional intimacy, and potential to maximize sexual ability and quality of life. Spinal cord injury is a traumatic, life-altering event that is usually associated with loss of motor and sensory function, as well as sexual impairment. At the time of injury, the individual is faced with devastating loss and an abundance of new information in a setting of extreme stress and challenge. In the acute rehabilitation setting, there is often a considerable void in providing education and resources regarding sexual concerns and needs. There is a positive relationship between sexual education and sexual activity. The impact of inadequate sexual counseling and education as a part of rehabilitation can be deleterious.
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Affiliation(s)
- Marika J. Hess
- Spinal Cord Injury Service, VA Boston Healthcare System, West Roxbury, MA, USA; Physical Medicine and Rehabilitation, Tufts School of Medicine, Boston, MA, USA; and Harvard Medical School, Boston, MA, USA,Correspondence to: Marika J. Hess, Spinal Cord Injury Service (SCI #128), VA Boston Healthcare System, 1400 VFW Parkway, West Roxbury, MA 02132, USA.
| | - Sigmund Hough
- Spinal Cord Injury Service, VA Boston Healthcare System, West Roxbury, MA, USA; Harvard Medical School, Boston, MA, USA; and Boston University School of Medicine, Boston, MA, USA
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Sexualität bei chronischen neurologischen Erkrankungen. NeuroRehabilitation 2010. [DOI: 10.1007/978-3-642-12915-5_28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Courtois F, Charvier K, Leriche A, Côté M, Lemieux A. L’évaluation et le traitement des troubles des réactions sexuelles chez l’homme et la femme blessés médullaires. SEXOLOGIES 2009. [DOI: 10.1016/j.sexol.2007.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Prevalence and Predictors of Sexual Dysfunction 12 Months After Major Trauma: A National Study. ACTA ACUST UNITED AC 2008; 65:1045-52; discussion 1052-3. [DOI: 10.1097/ta.0b013e3181896192] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lombardi G, Macchiarella A, Cecconi F, Aito S, Del Popolo G. Sexual life of males over 50 years of age with spinal-cord lesions of at least 20 years. Spinal Cord 2008; 46:679-83. [DOI: 10.1038/sc.2008.37] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Ergin S, Gunduz B, Ugurlu H, Sivrioglu K, Oncel S, Gok H, Erhan B, Levendoglu F, Senocak O. A placebo-controlled, multicenter, randomized, double-blind, flexible-dose, two-way crossover study to evaluate the efficacy and safety of sildenafil in men with traumatic spinal cord injury and erectile dysfunction. J Spinal Cord Med 2008; 31:522-31. [PMID: 19086709 PMCID: PMC2607124 DOI: 10.1080/10790268.2008.11753647] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND/OBJECTIVE To show the efficacy, safety, and tolerability of sildenafil in men with erectile dysfunction (ED) associated with complete or incomplete spinal cord injury (SCI) and to assess its effects on quality of life (QoL) using the Life-Satisfaction Check List. METHODS This was a placebo-controlled, multicenter, randomized, double-blind, flexible-dose, 2-way crossover study with a 2-week washout period between each phase. Patients with ED attributable to SCI (Sexual Health Inventory-Male score < or =21) received 50 to 100 mg sildenafil (n = 24) or placebo (n = 26). RESULTS Compared with placebo, sildenafil produced higher levels of successful sexual stimulation, intercourse success, satisfaction with sexual life and sexual relationship, erectile function, overall sexual satisfaction, and an improved Erectile Dysfunction Inventory of Treatment Satisfaction score, with no clinically relevant effects on vital signs. Sildenafil seemed more effective in patients with incomplete SCI than in those with complete SCI, producing significant improvements, compared with placebo, in a number of measures only in patients with incomplete SCI. All patients who expressed a preference selected sildenafil over placebo, although the drug had no effect on patient QoL. Sildenafil was well tolerated, with a profile comparable to that of placebo. CONCLUSIONS Compared with placebo, treatment with oral sildenafil safely and effectively improved erectile function in patients with ED attributable to SCI, especially in those with incomplete injury, and was the agent of choice in those who expressed a preference.
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Affiliation(s)
- Sureyya Ergin
- 1Department of Physical Medicine and Rehabilitation, Medical School of Ankara University, Ankara, Turkey
| | - Berrin Gunduz
- 2Ministry of Health 7a Yil Physical Health and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Hatice Ugurlu
- 3Department of Physical Medicine and Rehabilitation, Medical School, Selcuk University, Konya, Turkey
| | - Koncuy Sivrioglu
- 4Department of Physical Medicine and Rehabilitation, Medical School, Uludag University, Bursa, Turkey
| | - Sema Oncel
- 5Department of Physical Medicine and Rehabilitation, Medical School, Dokuz Eylūl University, Izmir, Turkey
| | - Haydar Gok
- 1Department of Physical Medicine and Rehabilitation, Medical School of Ankara University, Ankara, Turkey
| | - Belgin Erhan
- 2Ministry of Health 7a Yil Physical Health and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Funda Levendoglu
- 3Department of Physical Medicine and Rehabilitation, Medical School, Selcuk University, Konya, Turkey
| | - Ozlem Senocak
- 5Department of Physical Medicine and Rehabilitation, Medical School, Dokuz Eylūl University, Izmir, Turkey
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Ricciardi R, Szabo CM, Poullos AY. Sexuality and Spinal Cord Injury. Nurs Clin North Am 2007; 42:675-84; viii-ix. [DOI: 10.1016/j.cnur.2007.08.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Anderson KD, Borisoff JF, Johnson RD, Stiens SA, Elliott SL. Long-term effects of spinal cord injury on sexual function in men: implications for neuroplasticity. Spinal Cord 2006; 45:338-48. [PMID: 17016492 DOI: 10.1038/sj.sc.3101978] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Secure, web-based survey. OBJECTIVES Elicit specific information about sexual function from men with spinal cord injuries (SCI). SETTING World-wide web. METHODS Individuals 18 years or older living with SCI obtained a pass-code to enter a secure website and then answered survey questions. RESULTS The presence of genital sensation was positively correlated with the ability to feel a build up of sexual tension in the body during sexual stimulation and in the feeling that mental arousal translates to the genitals as physical sensation. There was an inverse relationship between developing new areas of arousal above the level of lesion and not having sensation or movement below the lesion. A positive relationship existed between the occurrence of spasticity during sexual activity and erectile ability. Roughly 60% of the subjects had tried some type of erection enhancing method. Only 48% had successfully achieved ejaculation postinjury and the most commonly used methods were hand stimulation, sexual intercourse, and vibrostimulation. The most commonly cited reasons for trying to ejaculate were for pleasure and for sexual intimacy. Less than half reported having experienced orgasm postinjury and this was influenced by the length of time postinjury and sacral sparing. CONCLUSION SCI not only impairs male erectile function and ejaculatory ability, but also alters sexual arousal in a manner suggestive of neuroplasticity. More research needs to be pursued in a manner encompassing all aspects of sexual function.
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Affiliation(s)
- K D Anderson
- Department of Neurological Surgery, Reeve-Irvine Research Center, University of California, Irvine, CA 92697, USA
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Pannek J, Braun PM, Diederichs W, Hohenfellner M, Jünemann KP, Madersbacher H, Reitz A, Schumacher S, Stöhrer M. 100 Jahre Urologie in Deutschland. Urologe A 2006; 45 Suppl 4:195-202. [PMID: 16858604 DOI: 10.1007/s00120-006-1141-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- J Pannek
- Schwerpunkt Neuro-Urologie, Urologische Klinik, Ruhr-Universität Bochum, Marienhospital Herne, Widumer Strasse 8, 44627 Herne.
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Zermann DH, Kutzenberger J, Sauerwein D, Schubert J, Loeffler U. Penile prosthetic surgery in neurologically impaired patients: long-term followup. J Urol 2006; 175:1041-4; discussion 1044. [PMID: 16469612 DOI: 10.1016/s0022-5347(05)00344-7] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2005] [Indexed: 11/27/2022]
Abstract
PURPOSE Penile prosthetics are a viable option for erectile dysfunction in neurologically impaired patients. Penile implants can also be used to facilitate the management of urinary drainage when penile retraction has made this difficult. MATERIALS AND METHODS Between 1980 and 1996, 245 neurologically impaired patients with a mean age of 40.8 years (range 16 to 75), including 188 with paraplegia, 57 with quadriplegia and 197 with spinal cord injuries, were treated for erectile dysfunction and/or urinary incontinence with penile prosthesis implantation. The mean history of paralysis was 11.2 years (range 1 to 52). After neuro-urological evaluation all patients included in this study were considered candidates for penile prosthesis implantation. A followup program for treatment success, patient satisfaction, problems and complications was subsequently initiated. RESULTS During 17 years a total of 293 surgical procedures in 245 patients were done with the implantation of 147 semirigid (Jonas), 113 self-contained inflatable (Dynaflex) and 33 inflatable 3-piece (AMS 700) prostheses. There were 3 patient groups based on the indication for penile prosthetic surgery, namely group 1-134 patients with urinary management only, group 2-60 with erectile dysfunction only, and group 3-51 with urinary management and erectile dysfunction. At a mean followup of 7.2 years (maximum 17) 195 patients were reevaluated in clinic. In 122 patients (90.3%) urinary management problems were resolved. Erectile dysfunction treatment was successful in 76 patients (82.6%). There were 43 revisions for technical reasons and infections. The infection rate was 5% (12 patients). The perforation rate was different for different implant devices, that is 18.1% (15 of 83 cases) for semirigid devices, 2.4% (2 of 84) for self-contained inflatable devices and 0% (0 of 28) for inflatable 3-piece devices. CONCLUSIONS The implantation of a penile prosthesis is a safe procedure for erectile dysfunction and/or urinary incontinence in neurologically impaired patients. Based on technical advances the complication rates significantly decreased during the years. The implantation of an inflatable 3-piece penile prosthesis in a neurologically impaired patient is a safe and viable procedure. Indications include the management of erectile dysfunction and problematic urinary collection.
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Affiliation(s)
- Dirk-Henrik Zermann
- Department of Urology, University Hospital, Friedrich-Schiller-University Jena, Jena, Germany.
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Francis SH, Corbin JD. Phosphodiesterase-5 Inhibition: the Molecular Biology of Erectile Function and Dysfunction. Urol Clin North Am 2005; 32:419-29, vi. [PMID: 16291034 DOI: 10.1016/j.ucl.2005.08.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This article discusses the role of phosphodiesterase-5 (PDE-5) inhibition in the molecular biology of erectile function and dysfunction. Commercially marketed PDE-5 inhibitors are highly specific for PDE-5, and in the face of continuing cyclic GMP (cGMP) synthesis,elevate cellular cGMP. This elevation results from direct competitive inhibition of PDE-5 and from blocking the negative feedback regulation of the enzyme. Elevation of cGMP activates cGMP-dependent protein kinase, which mediates the effects of the cGMP-signaling pathway to decrease smooth muscle tone and dilate penile vascular smooth muscle. By exploiting features of PDE-5 regulatory mechanisms that modulate PDE-5 function, the inhibitors enhance their own potencies.
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Affiliation(s)
- Sharron H Francis
- Department of Molecular Physiology and Biophysics, Light Hall, Room 702, Vanderbilt University School of Medicine, Nashville, TN 37232-0615, USA.
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Utida C, Truzzi JC, Bruschini H, Simonetti R, Cedenho AP, Srougi M, Ortiz V. Male infertility in spinal cord trauma. Int Braz J Urol 2005; 31:375-83. [PMID: 16137408 DOI: 10.1590/s1677-55382005000400013] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2004] [Accepted: 03/20/2005] [Indexed: 11/22/2022] Open
Abstract
Every year there are 10 thousand new cases of patients victimized by spinal cord trauma (SCT) in the United States and it is estimated that there are 7 thousand new cases in Brazil. Eighty percent of patients are fertile males. Infertility in this patient group is due to 3 main factors resulting from spinal cord lesions: erectile dysfunction, ejaculatory disorder and low sperm counts. Erectile dysfunction has been successfully treated with oral and injectable medications, use of vacuum devices and penile prosthesis implants. The technological improvement in penile vibratory stimulation devices (PVS) and rectal probe electro-ejaculation (RPE) has made such procedures safer and accessible to patients with ejaculatory dysfunction. Despite the normal number of spermatozoa found in semen of spinal cord-injured patients, their motility is abnormal. This change does not seem to be related to changes in scrotal thermal regulation, frequency of ejaculation or duration of spinal cord damage but to factors related to the seminal plasma. Despite the poor seminal quality, increasingly more men with SCT have become fathers through techniques ranging from simple homologous insemination to sophisticated assisted reproduction techniques such as intracytoplasmic sperm injection (ICSI).
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Affiliation(s)
- Cristiano Utida
- Department of Urology, Paulista School of Medicine, Federal University of Sao Paulo, UNIFESP, Sao Paulo, Brazil
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