Electroejaculation in men with spinal cord injury: a step-by-step video demonstration

To demonstrate the proper technique to perform electroejacuation (EEJ) in men with spinal cord injury (SCI) for the purpose of inducing ejaculation. A video demonstration of the proper technique to perform EEJ in men with SCI using the Seager model 14 electroejaculation machine. Major university medical center. Men with SCI; institutional review board approval was obtained, and all subjects signed an informed consent form. Spinal cord injury occurs mostly in young men where the majority suffer from ejaculatory dysfunction. The method of choice to induce ejaculation in penile vibratory stimulation (PVS). PVS is successful in 86% of men with SCI whose level of injury is T10 or rostral. If PVS fails or the level is Caudal to T10, the patient is referred for EEJ. This video will demonstrate the proper technique for successful ejaculation using EEJ. Patients with history of autonomic dysreflexia or their level of injury is T6 or rostral are pretreated with 10–20 mg of nifedipine sublingually 10 minutes before stimulation. The patient is then placed in the lateral decubitus position. The bladder is emptied, and a buffer is instilled. An anoscopy is performed, and a rectal probe is placed. A current is delivered until an antegrade ejaculation is retrieved. A retrograde specimen is collected and examined for sperm identification. Patients with complete SCI (no sensory or motor function is preserved in sacral segments S4–S5) can undergo EEJ without anesthesia. Patients with incomplete SCI (significant nerve sparing or normal sensations) will experience pain during stimulation, and general anesthesia is recommended without the use of muscle relaxing agents. Successful ejaculation after performing EEJ in men with SCI. Electroejacuation is successful in 95% of men with SCI and in nearly 100% if general anesthesia is used. Outcomes of in vitro fertilization or intracytoplasmic sperm injection after EEJ showed 37.5% pregnancy rate per cycle, 50.0% pregnancy rate per couple, 33.3% live birth rate per cycle, and 43.8% live birth rate per couple. No complications due to EEJ were observed in 953 trials, and none occurred in the patients presented in this video demonstration. Electroejacuation is a safe and reliable method for induction of ejaculation in men with SCI who fail a trial of PVS. Electroeyaculación en hombres con lesión en la espina dorsal: un video demostrativo paso a paso. Demostrar la técnica adecuada para realizar la electroeyaculación (EEJ) en hombres con lesión en la espina dorsal (SCI) con el propósito de inducir la eyaculación. Una video demostrativo de la técnica adecuada para realizar la EEJ en hombres con SCI utilizando la máquina de electroeyaculación Seager modelo 14. Centro médico universitario. Hombres con SCI; se obtuvo la aprobación de un comité ético y todos los sujetos firmaron el consentimiento informado. La lesión de la médula espinal ocurre principalmente en hombres jóvenes, donde la mayoría padece disfunción eyaculatoria. El método elegido para inducir la eyaculación en la estimulación vibratoria del pene (PVS). La PVS tiene éxito en el 86% de los hombres con SCI cuyo nivel de lesión es T10 o rostral. Si la PVS falla o el nivel es de Caudal a T10, se refiere al paciente para EEJ. Este video demostrará la técnica adecuada para una eyaculación exitosa usando EEJ. Los pacientes con antecedentes de disreflexia autonómica o con un nivel de lesión de T6 o rostral son tratados previamente con 10 a 20 mg de nifedipina por vía sublingual 10 minutos antes de la estimulación. A continuación, se coloca al paciente en posición de decúbito lateral. La vejiga se vacía y se instila un tampón. Se realiza una anoscopia y se coloca una sonda rectal. Se da una corriente hasta que se recupera la eyaculación anterógrada. Se recolecta y examina una muestra retrógrada para identificar los espermatozoides. Pacientes con SCI completa (no se conserva ninguna función sensorial o motora en los segmentos sacros S4-S5) puede someterse a EEJ sin anestesia. Pacientes con SCI incompleta (sensaciones normales o con preserva significativa de los nervios) experimentarán dolor durante la estimulación, y se recomienda anestesia general sin el uso de relajantes musculares. Eyaculación exitosa después de realizar EEJ en hombres con SCI. La electroeyaculación es exitosa en un 95% de los hombres y cercana al 100% si se realiza una anestesia general. Los resultados de la fecundación in vitro o de la inyección espermática intracitoplasmática después de EEJ mostró un 37.5 % de tasa de embarazo por ciclo, 50% de tasa de embarazo por pareja, 33.3% de recién nacido vivo por ciclo y 43.8% de recién nacido vivo por pareja. Ninguna complicación a causa de EEJ fue observada en los 953 ensayos y ninguna ocurrió en los pacientes presentados en este video demostrativo. La electroeyaculación es un método seguro y confiable para inducir la eyaculación en hombres con SCI en los que falla el ensayo con PVS

Safety of a novel treatment to improve sperm motility in men with spinal cord injury

Seminal plasma of men with spinal cord injury (SCI) contains high concentrations of cytokines. Neutralizing these target cytokines did not damage sperm DNA or sperm viability, indicating that this method may hold promise as a safe therapy for improving sperm motility in men with SCI

Brown‐Colored Semen in Men With Spinal Cord Injury

The interesting condition of brown‐colored semen has often been observed during assisted ejaculation of men with spinal cord injury (SCI). This condition has not been reported in the literature, and its cause is unknown. To investigate this condition, the present study examined the incidence and quality of brown semen and its relationship to level of SCI, time since SCI, number of successive ejaculations, ejaculation frequency, and ejaculation method in a total of 664 semen specimens from 162 SCI men. In addition, a microscopic evaluation was performed on brown semen specimens from SCI men, not‐brown specimens from SCI men, and normally colored specimens from normal men. The results showed that 27% of SCI subjects had brown semen on at least one ejaculation. There was no difference between men producing and men not producing brown semen in age, level of injury, or years postinjury. The duration of anejaculation, number of successive ejaculations, and frequency of ejaculation were not associated with occurrence of brown semen. Sperm concentration and sperm motility were not significantly different in brown and not‐brown specimens. Specimens from subjects who produced brown semen had similar pH but lower volume than specimens from subjects who did not produce brown semen. Brown semen had a thin consistency more often than not‐brown semen. Brown specimens contained intact red blood cells (RBCs) and/or heme pigment more often than not‐brown specimens; however, one half and one third of the specimens, respectively, contained neither RBCs nor heme pigment. The cause of brown semen is unknown but may relate to seminal‐vesicle dysfunction

Semen quality remains stable during the chronic phase of spinal cord injury: a longitudinal study

In a longitudinal study we examined changes in semen quality with time during the chronic phase of spinal cord injury. Included in this study were 87 men with spinal cord injury who underwent 2 or more semen retrieval procedures with a minimum of 3 years between the first and last procedures. Patients were selected from our database of 500 with spinal cord injury who were volunteers enrolled in the Male Fertility Research Program of the Miami Project to Cure Paralysis from January 1, 1991 through April 31, 2009. Semen was collected by masturbation, penile vibratory stimulation or electroejaculation. Semen analysis was done according to WHO criteria. We used a statistical generalized linear mixed model to analyze changes in sperm concentration, total sperm count, total motile sperm count and sperm motility with time. Mean patient age was 30.1 years (range 16 to 48) and mean time after injury at the initial sperm retrieval procedure was 7.1 years (range 1 to 26). Sperm concentration decreased slightly with time but all other parameters were unchanged, including total sperm count, indicating a stable, null pattern in measures with time. Semen quality does not show clinically significant progressive changes during years after injury in men with spinal cord injury. This information is relevant for urologists who counsel these patients on family planning. Also, routine sperm freezing for fertility preservation is not indicated in this patient population

Semen quality in spinal cord injured men: Does it progressively decline postinjury?

Objective: To determine if semen quality of men with spinal cord injury (SCI) undergoes a progressive decline as a function of years postinjury. Design: A retrospective analysis of cross-sectional data. Setting: University-based research center. Subjects: Semen quality was examined in 638 specimens from 125 men with SCI. Intervention: Penile vibratory stimulation, electroejaculation, and masturbation were used as semen retrieval methods. Routine semen analysis was performed to evaluate semen quality. Main Outcome Measures: Sperm concentration, total sperm count, and percent sperm motility were examined at 2-year intervals from men whose injuries had occurred 6 weeks to 26 years earlier. Results: No difference in any semen parameter was found as a function of time postinjury. Conclusions: Semen quality in men with SCI does not progressively decline after the SCI. Men with SCI who are considering biologic fatherhood should be advised that the number of years after injury need not be a determinant in deciding when to start a family

Comparison of three methods of penile vibratory stimulation for semen retrieval in men with spinal cord injury

Prospective, three-way crossover design. Penile vibratory stimulation (PVS) is recommended as the first line of treatment for semen retrieval in anejaculatory men with spinal cord injury (SCI). This study compared ejaculatory success rates and patient preference for three methods of PVS within the same group of men with SCI. Major medical university. Fifteen men with SCI each received three methods of PVS. Method 1 (M1): applying one FertiCare Personal device to the dorsum or frenulum of the glans penis; Method 2 (M2): 'sandwiching' the glans penis between two FertiCare devices; Method 3 (M3): sandwiching the glans penis between the two vibrating surfaces of the Viberect-X3 device. The order of M1, M2 and M3 was varied to control for sequencing effects. Following each PVS trial, subjects rated their experience on a questionnaire with scaled responses. Ejaculation success rates were high for each method; however, ejaculation latency was significantly longer with M3 compared with M1 or M2. In survey questions about patient preference, there were no significant differences between M1 and M2. In contrast, M3 was rated lower than M1 and M2 in patient preference. Semen collection may be more difficult with the Viberect device. On the basis of these findings, we recommend attempting PVS with one FertiCare device. If that fails, use two FertiCare devices. Although the Viberect-X3 was preferred less by patients, it had similar efficacy as the Ferticare vibrator(s) and may be suitable for home use by some patients