2040 A SYSTEMATIC REVIEW AND META-ANALYSIS OF ANEJACULATION IN SPINAL CORD INJURED PATIENTS IN FAVOUR OF A SPINAL GENERATOR OF EJACULATION

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You have accessJournal of UrologyInfertility: Basic Research, Physiology, Pathophysiology1 Apr 20132040 A SYSTEMATIC REVIEW AND META-ANALYSIS OF ANEJACULATION IN SPINAL CORD INJURED PATIENTS IN FAVOUR OF A SPINAL GENERATOR OF EJACULATION Clément Chéhensse, Stéphane Bahrami, Pierre Denys, Pierre Clément, and François Giuliano Clément ChéhensseClément Chéhensse Montigny-le-Bretonneux, France More articles by this author , Stéphane BahramiStéphane Bahrami Garches, France More articles by this author , Pierre DenysPierre Denys Garches, France More articles by this author , Pierre ClémentPierre Clément Montigny-le-Bretonneux, France More articles by this author , and François GiulianoFrançois Giuliano Garches, France More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2459AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES After spinal cord injury (SCI) most men cannot ejaculate, although ejaculation can be obtained with medical assistance. There are gaps in the understanding of the neurophysiology of ejaculation and the pathophysiology of anejaculation in SCI males. Notably, the existence of a spinal generator of ejaculation, which has been identified in the rat, is not substantiated in the human. Studies reporting ejaculation after SCI have been reviewed in the light of recent advances on the physiology of ejaculation, especially regarding the spinal neurophysiology. METHODS Using 4 databases since 1955, 513 studies were identified and 45 fulfilled the following inclusion criteria 1) characterisation of the SCI (completeness and either upper limit or somatic reflex function below this upper limit that allowed to estimate lower limit of SCI) and 2) antegrade ejaculation rate. A total of 3795 patients were pooled together. Subgroups analyses were performed depending on i) the method used to elicit ejaculation: ecological stimulation i.e. masturbation or coïtus, penile vibratory stimulation (PVS) with or without oral midodrine before stimulation and masturbation following acetylcholine esterase (AchE) inhibitors it prostigmine or sc physostigmine ii) SCI completeness according to ASIA Impairment Scale and iii) SCI upper and lower limit. RESULTS Ejaculation rate in patients with complete SCI was 11.8%, 45.7% and 54.7% respectively during masturbation or coïtus, in response to penile vibratory stimulation (PVS) and during masturbation after AchE inhibitors. Complete injury of the sympathetic centres (spinal segments T12 to L2) or of the parasympathetic and somatic centres (spinal segments S2 to S4) totally disrupted ejaculation in response to PVS. AchE inhibitors followed by masturbation elicited ejaculation in 5 and 31% of men with complete injury of the T12 to L2 and S2 to S4 segments respectively. Controlling for the number of T12 to L2 segments completely injured, ejaculation rate was significantly lower when injury extended to spinal segment L3 and below. Complete injury of segments S2 to S4 precluded the occurrence of rhythmic forceful ejaculation. CONCLUSIONS These data confirm and reinforce the crucial role of the thoracolumbar sympathetic and sacral parasympathetic centres in emission and sacral somatic centre in expulsion. In addition this review of the literature strongly suggests that the segments L3 to L5 harbour a spinal generator of ejaculation in human. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e837-e838 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Clément Chéhensse Montigny-le-Bretonneux, France More articles by this author Stéphane Bahrami Garches, France More articles by this author Pierre Denys Garches, France More articles by this author Pierre Clément Montigny-le-Bretonneux, France More articles by this author François Giuliano Garches, France More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...