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Sexual Health in the Neurogenic Patient. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00605-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Walker DT, Mills JN. Erectile Dysfunction and Neurological Comorbidities: a Contemporary Review. CURRENT SEXUAL HEALTH REPORTS 2020. [DOI: 10.1007/s11930-020-00265-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Del Popolo G, Cito G, Gemma L, Natali A. Neurogenic Sexual Dysfunction Treatment: A Systematic Review. Eur Urol Focus 2020; 6:868-876. [DOI: 10.1016/j.euf.2019.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 11/11/2019] [Accepted: 12/10/2019] [Indexed: 11/26/2022]
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Abstract
PURPOSE OF REVIEW Lower urinary tract and sexual dysfunction are commonly reported sequelae of neurologic disease and have a significant impact on quality of life. This article presents an up-to-date summary of the clinical presentation, investigations, and treatment options for urogenital dysfunction in patients with neurologic disease. RECENT FINDINGS The pattern of lower urinary tract dysfunction is influenced by the site of the neurologic lesion. The risk for developing upper urinary tract damage is considerably less in patients with slowly progressive nontraumatic neurologic disorders, as compared to those with spinal cord injury or spina bifida. Investigations such as urinalysis, ultrasonography, and urodynamics provide further information about the cause and nature of lower urinary tract dysfunction. Antimuscarinic agents are the first-line management of urinary incontinence; however, side effect profile and anticholinergic burden should be considered when prescribing medications. β3-Adrenergic receptor agonists are a promising alternative oral medication. Tibial and sacral neuromodulation have been shown to be effective for managing incontinence, as well as urinary retention due to Fowler syndrome. Intradetrusor injections of onabotulinumtoxinA have revolutionized the management of neurogenic detrusor overactivity. SUMMARY Neurologic patients reporting urogenital symptoms require a comprehensive evaluation for planning a patient-tailored approach to management. Neurologists are increasingly inquiring about lower urinary tract and sexual functions and becoming involved in the management of these disorders.
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Ibrahim E, Brackett NL, Lynne CM. Advances in the management of infertility in men with spinal cord injury. Asian J Androl 2017; 18:382-90. [PMID: 27048781 PMCID: PMC4854086 DOI: 10.4103/1008-682x.178851] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Couples with a spinal cord injured male partner require assisted ejaculation techniques to collect semen that can then be further used in various assisted reproductive technology methods to achieve a pregnancy. The majority of men sustaining a spinal cord injury regardless of the cause or the level of injury cannot ejaculate during sexual intercourse. Only a small minority can ejaculate by masturbation. Penile vibratory stimulation and electroejaculation are the two most common methods used to retrieve sperm. Other techniques such as prostatic massage and the adjunct application of other medications can be used, but the results are inconsistent. Surgical sperm retrieval should be considered as a last resort if all other methods fail. Special attention must be paid to patients with T6 and rostral levels of injury due to the risk of autonomic dysreflexia resulting from stimulation below the level of injury. Bladder preparation should be performed before stimulation if retrograde ejaculation is anticipated. Erectile dysfunction is ubiquitous in the spinal cord injured population but is usually easily managed and does not pose a barrier to semen retrieval in these men. Semen analysis parameters of men with spinal cord injury are unique for this population regardless of the method of retrieval, generally presenting as normal sperm concentration but abnormally low sperm motility and viability. When sperm retrieval is desired in this population, emphasis should be placed on initially trying the simple methods of penile vibratory stimulation or electroejaculation before resorting to more advanced and invasive surgical procedures.
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Affiliation(s)
| | - Nancy L Brackett
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL; Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
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Fortune RD, Grill RJ, Beeton C, Tanner M, Huq R, Loose DS. Changes in Gene Expression and Metabolism in the Testes of the Rat following Spinal Cord Injury. J Neurotrauma 2016; 34:1175-1186. [PMID: 27750479 DOI: 10.1089/neu.2016.4641] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Spinal cord injury (SCI) results in devastating changes to almost all aspects of a patient's life. In addition to a permanent loss of sensory and motor function, males also will frequently exhibit a profound loss of fertility through poorly understood mechanisms. We demonstrate that SCI causes measureable pathology in the testis both acutely (24 h) and chronically up to 1.5 years post-injury, leading to loss in sperm motility and viability. SCI has been shown in humans and rats to induce leukocytospermia, with the presence of inflammatory cytokines, anti-sperm antibodies, and reactive oxygen species found within the ejaculate. Using messenger RNA and metabolomic assessments, we describe molecular and cellular changes that occur within the testis of adult rats over an acute to chronic time period. From 24 h, 72 h, 28 days, and 90 days post-SCI, the testis reveal a distinct time course of pathological events. The testis show an acute drop in normal sexual organ processes, including testosterone production, and establishment of a pro-inflammatory environment. This is followed by a subacute initiation of an innate immune response and loss of cell cycle regulation, possibly due to apoptosis within the seminiferous tubules. At 1.5 years post-SCI, there is a chronic low level immune response as evidenced by an elevation in T cells. These data suggest that SCI elicits a wide range of pathological processes within the testes, the actions of which are not restricted to the acute phase of injury but rather extend chronically, potentially through the lifetime of the subject. The multiplicity of these pathological events suggest a single therapeutic intervention is unlikely to be successful.
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Affiliation(s)
- Ryan D Fortune
- 1 Department of Integrative Biology and Pharmacology, UTHealth , Houston, Texas
| | - Raymond J Grill
- 1 Department of Integrative Biology and Pharmacology, UTHealth , Houston, Texas
| | - Christine Beeton
- 2 Department of Molecular Physiology and Biophysics, Baylor College of Medicine , Houston, Texas
| | - Mark Tanner
- 2 Department of Molecular Physiology and Biophysics, Baylor College of Medicine , Houston, Texas
| | - Redwan Huq
- 2 Department of Molecular Physiology and Biophysics, Baylor College of Medicine , Houston, Texas
| | - David S Loose
- 1 Department of Integrative Biology and Pharmacology, UTHealth , Houston, Texas
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Steadman CJ, Hubscher CH. Sexual Function after Spinal Cord Injury: Innervation, Assessment, and Treatment. CURRENT SEXUAL HEALTH REPORTS 2016. [DOI: 10.1007/s11930-016-0067-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Shridharani AN, Brant WO. The treatment of erectile dysfunction in patients with neurogenic disease. Transl Androl Urol 2016; 5:88-101. [PMID: 26904415 PMCID: PMC4739980 DOI: 10.3978/j.issn.2223-4683.2016.01.07] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Erectile dysfunction (ED) related to compromise of the nervous system is an increasingly common occurrence. This may be due to the multifactorial nature of ED, the myriad of disorders affecting the neurotransmission of erectogenic signals, and improved awareness and diagnosis of ED. Nevertheless, neurogenic ED remains poorly understood and characterized. Disease related factors such as depression, decreased physical and mental function, the burden of chronic illness, and loss of independence may preclude sexual intimacy and lead to ED as well. The amount of data regarding treatment options in subpopulations of differing neurologic disorders remains scarce except for men with spinal cord injury. The treatment options including phosphodiesterase inhibitors, intracavernosal or intraurethral vasoactive agents, vacuum erection devices (VED) and penile prosthetic implantation remain constant. This review discusses the options in specific neurologic conditions, and briefly provides insight into new and future developments that may reshape the management of neurogenic ED.
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Affiliation(s)
- Anand N Shridharani
- 1 Department of Urology, University of Tennessee College of Medicine, Chattanooga, TN, USA ; 2 Division of Urology, University of Utah, Salt Lake City, Utah, USA
| | - William O Brant
- 1 Department of Urology, University of Tennessee College of Medicine, Chattanooga, TN, USA ; 2 Division of Urology, University of Utah, Salt Lake City, Utah, USA
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Lee HS, Lee YJ, Chung YH, Lee MY, Kim ST, Ko SK, Momoi M, Kondoh Y, Sasaki F, Jeong JH. In vitro and in vivo evaluation of tissue-cultured mountain ginseng on penile erection. J Ginseng Res 2015; 40:334-343. [PMID: 27746685 PMCID: PMC5052409 DOI: 10.1016/j.jgr.2015.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 10/21/2015] [Accepted: 10/26/2015] [Indexed: 11/26/2022] Open
Abstract
Background Progressed tissue culture techniques have allowed us to easily obtain mass products of tissue-cultured mountain ginseng over 100 yr old (TCMG-100). We investigated the effects of TCMG-100 extract on erectile function using in vitro and in vivo studies. Methods To examine the relaxation effects and mechanisms of action of TCMG-100 on rabbit cavernosal strips evaluated in an organ bath. To investigate the long-term treatment effect of TCMG-100, 8-wk administration was performed. After administration of TCMG-100, intracavernosal pressure, cyclic guanosine monophosphate and nitric oxide (NO) levels of cavernosal tissue, serum testosterone level, histological observation of collagen fiber, endothelium, smooth muscle cell, and transforming growth factor-β1 were investigated. Results TCMG-100 extract displayed dose-dependent relaxation effects on precontracted rabbit corporal smooth muscle. The TCMG-100-induced relaxation was significantly reduced by removing the endothelium, and treatment with an NO synthase inhibitor or NO scavenger. Eight weeks of TCMG-100 administration increased intracavernosal pressure in a rat model. The levels of cyclic guanosine monophosphate and NO in the corpus callosum and serum testosterone level were also increased by TCMG-100 treatment. Furthermore, histological evaluation of collagen, smooth muscle, and endothelium showed increases in endothelium and smooth muscle, and a decrease in transforming growth factor-β1 expression. Conclusion These relaxation effects on corporal smooth muscle and increased erectile function suggest that TCMG-100 might be used as an alternative herbal medicine to improve erectile function.
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Affiliation(s)
- Ho Sung Lee
- Department of Pharmacology, College of Medicine, Chung-ang University, Seoul, Korea
| | - Young Joo Lee
- Department of Pharmacology, College of Medicine, Chung-ang University, Seoul, Korea
| | - Yoon Hee Chung
- Department of Anatomy, College of Medicine, Chung-ang University, Seoul, Korea
| | - Moo Yeol Lee
- Department of Physiology, College of Medicine, Chung-ang University, Seoul, Korea
| | - Sung Tae Kim
- Department of Pharmacology, College of Medicine, Chung-ang University, Seoul, Korea
| | - Sung Kwon Ko
- Department of Oriental Medical Food and Nutrition, Semyung University, Jecheon, Korea
| | | | | | | | - Ji Hoon Jeong
- Department of Pharmacology, College of Medicine, Chung-ang University, Seoul, Korea
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Lombardi G, Musco S, Wyndaele JJ, Del Popolo G. Treatments for erectile dysfunction in spinal cord patients: alternatives to phosphodiesterase type 5 inhibitors? A review study. Spinal Cord 2015; 53:849-54. [DOI: 10.1038/sc.2015.116] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 05/12/2015] [Accepted: 06/01/2015] [Indexed: 11/09/2022]
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Lombardi G, Musco S, Kessler TM, Marzi VL, Lanciotti M, Del Popolo G. Management of sexual dysfunction due to central nervous system disorders: a systematic review. BJU Int 2015; 115 Suppl 6:47-56. [DOI: 10.1111/bju.13055] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Giuseppe Lombardi
- Neuro-Urology Department; Careggi University Hospital; Florence Italy
| | - Stefania Musco
- Neuro-Urology Department; Careggi University Hospital; Florence Italy
| | - Thomas M. Kessler
- Neuro-Urology; Spinal Cord Injury Center and Research; Balgrist University Hospital; University of Zürich; Zürich Switzerland
| | | | | | - Giulio Del Popolo
- Neuro-Urology Department; Careggi University Hospital; Florence Italy
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Brackett NL. Infertility in men with spinal cord injury: research and treatment. SCIENTIFICA 2012; 2012:578257. [PMID: 24278717 PMCID: PMC3820516 DOI: 10.6064/2012/578257] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 11/08/2012] [Indexed: 06/02/2023]
Abstract
Spinal cord injury (SCI) occurs most often to young men. Following SCI, most men are infertile due to a combination of erectile dysfunction, ejaculatory dysfunction and semen abnormalities. Erectile dysfunction may be treated by the same therapies that are used in the general population. Similarly, the same treatments that are effective to assist conception in couples with non-SCI male factor patients are effective in assisting conception in SCI male-factor patients. The most apparent differences in male-factor symptoms between SCI and non-SCI patients are the high occurrences of anejaculation and atypical semen profiles in men with SCI. Methods available to assist ejaculation in men with SCI include penile vibratory stimulation and EEJ. Use of surgical sperm retrieval as the first line of treatment for anejaculation in men with SCI is controversial. Most men with SCI have a unique semen profile characterized by normal sperm concentration, but abnormally low sperm motility. Toxic substances in the semen contribute to this problem. Despite impaired sperm parameters, pregnancy outcomes using sperm from men with SCI are similar to pregnancy outcomes using sperm from non-SCI men. Future studies should focus on improving natural ejaculation and improving semen quality in these men.
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Affiliation(s)
- Nancy L. Brackett
- Lois Pope Life Center, The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Room 2-17, 1095 NW 14th Terrace, Miami, FL 33136, USA
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Lombardi G, Nelli F, Celso M, Mencarini M, Del Popolo G. Treating Erectile Dysfunction and Central Neurological Diseases with Oral Phosphodiesterase Type 5 Inhibitors. Review of the Literature. J Sex Med 2012; 9:970-85. [DOI: 10.1111/j.1743-6109.2011.02615.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Most men with spinal cord injury (SCI) are infertile. Erectile dysfunction, ejaculatory dysfunction and semen abnormalities contribute to the problem. Treatments for erectile dysfunction include phosphodiesterase type 5 inhibitors, intracavernous injections of alprostadil, penile prostheses, and vacuum constriction devices. In anejaculatory patients who wish to father children, semen retrieval is necessary. Penile vibratory stimulation is recommended as the first line of treatment. Patients who fail penile vibratory stimulation can be referred for electroejaculation. If this approach is not possible, prostate massage is an alternative. Surgical sperm retrieval should be considered as a last resort when other methods fail. Most men with SCI have a unique semen profile characterized by normal sperm count but abnormally low sperm motility. Scientific investigations indicate that accessory gland dysfunction and abnormal semen constituents contribute to the problem. Despite abnormalities, sperm from men with SCI can successfully induce pregnancy. In selected couples, the simple method of intravaginal insemination is a viable option. Another option is intrauterine insemination. The efficacy of intrauterine insemination increases as the total motile sperm count inseminated increases. In vitro fertilization and intracytoplasmic sperm injection are options in cases of extremely low total motile sperm count. Reproductive outcomes for SCI male factor infertility are similar to outcomes for general male factor infertility.
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