V11-09 PENILE VIBRATORY STIMULATION (PVS): THE METHOD OF CHOICE FOR ANEJACULATION AFTER SPINAL CORD INJURY

Abstract

You have accessJournal of UrologyCME1 Apr 2023V11-09 PENILE VIBRATORY STIMULATION (PVS): THE METHOD OF CHOICE FOR ANEJACULATION AFTER SPINAL CORD INJURY Emad Ibrahim Emad IbrahimEmad Ibrahim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003337.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Spinal cord injury (SCI) is the leading cause of anejaculation in young men. After SCI 90% of men with SCI will need a method of assisted ejaculation to achieve biological fatherhood. Penile vibratory stimulation (PVS) was popularized in 1994 after the production of the first vibrator specifically designed for semen retrieval in men with SCI. The success of this device was based on a calculated amplitude of 2.5 mm which was proven to be optimal for successfully producing an ejaculate. PVS is safe, reliable, can be performed by the male partner at home after an initial evaluation by a health care provider and yields the best sperm quality.A newly designed vibrator was produced in 2019 and was tested by a group of international experts for safety and efficacy. The study concluded the device was safe and effective in inducing ejaculation in men suffering from anejaculation after SCI. METHODS: Initial encounter: standard history, physical exam and level of injury determination using the International Standards for Neurological Classification of Spinal Cord Injury were performed. In addition, assessment of Hip Flexor Reflex and Bulbocavernosus Reflex was performed. Procedure: Patients with a level of injury at or rostral to T6 were pretreated with 10-40 mg of sublingual nifedipine to mange autonomic dysreflexia. The patient lied supine on the exam table and the vibrator was applied to the dorsum or frenulum of the glans penis. Stimulation was delivered in 2-minute increments to a maximum of 10 minutes per visit. Stimulation using 2 vibrators (Sandwich technique) or with abdominal electrical stimulation can be performed in select patients. Semen: Ejaculated semen was collected in a sterile cup and a semen analysis was performed after liquefaction. Bladder preparation using sperm wash medium was performed in patients suspected of having retrograde ejaculation. RESULTS: PVS was successful in 86% of men whose level of injury was T10 or rostral. A total of 3,698 PVS procedures were successfully performed by our group. The total motile sperm count in antegrade ejaculates produced by PVS was >5 million (lower limit considered for IUI) in 71% of ejaculates. CONCLUSIONS: PVS is a safe and effective method to manage anejaculation in men with SCI. Sperm can be obtained non surgically from most men with SCI. Sufficient sperm are available for simple insemination procedures. PVS should be considered as the method of choice for semen retrieval in this patient population. Source of Funding: Paralyzed Veterans of America (PVA) Educational Grant #877 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1001 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Emad Ibrahim More articles by this author Expand All Advertisement PDF downloadLoading ...