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Intracavernous injections in spinal cord injured men with erectile dysfunction, a systematic review and meta-analysis
Annals of Physical and Rehabilitation Medicine 59S (2016) e107–e108
Available online at
ScienceDirect www.sciencedirect.com
SCI fertility
Oral communications CO068
Intracavernous injections in spinal cord injured men with erectile dysfunction, a systematic review and meta-analysis Lucie Chochina 1,∗ , Florian Naudet 3 , Isabelle Bonan 1 , Clément Chehensse 1 , Mireille Damphousse 1 , Andrea Manunta 2 , Franc¸ois Giuliano 4 1 CHU de Rennes, MPR, Rennes, France 2 CHU Pontchaillou, urologie, Rennes, France 3 CHU Pontchaillou, pharmacologie, Rennes, France 4 Hopital R.-Poincaré, urologie, Garches, France ∗ Corresponding author. E-mail address: [email protected] (L. Chochina) Objective To review the efficacy of intracavernous injections (ICI) in spinal cord injured (SCI) men and to identify prognostic factors affecting the efficacy of ICI in this population. Material/patients and methods Systematic review of the literature using 5 databases. Articles published up to november 2014 using the keywords: alprostadil; papaverine; moxisylyte; alpha-blocking agent; phentolamine; intracavernous injection; spinal cord injuries; paraplegia; quadriplegia; erectile dysfunction; were included. Results Twenty-three studies were included (713 SCI patients). ICIs resulted in successful erections in 88% of patients. Erections were obtained respectively in 93% of patients with the combination of papaverine and phentolamine, in 91% with papaverine alone and in 80% with prostaglandin E1. The statistical analysis could not identify specific factors predictive of response to ICI. Discussion–conclusion ICIs are an effective treatment of erectile dysfunction in SCI men. No predictive factor for efficacy could be identified. Studies comparing the response to ICI in upper and lower motor neuron lesions could improve our understanding of ICI failure. CIs are an effective treatment of erectile dysfunction in SCI men. No predictive factor for efficacy could be identified. Studies comparing the response to ICI in upper and lower motor neuron lesions could improve our understanding of ICI failure. Keywords Paraplegia; Quadriplegia; Erectile dysfunction; Alprostadil; Papaverine Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2016.07.237
1877-0657/
CO069
Ejaculation in men living with a lumbosacral spinal cord injury. Retrospective study of 22 subjects Damien Waz 1,∗ , Kathleen Charvier 2 Hôpital Pierre-Wertheimer, SRPR, Bron, France 2 Hôpital Henry-Gabrielle, rééducation neuropérinéale et sexologique, Saint-Genis-Laval, France ∗ Corresponding author. E-mail address: muse [email protected] (D. Waz)
1
Objective The goal is to characterize the ejaculation rate and the type of ejaculation experienced by men living with a lumbosacral spinal cord injury. The secondary objective is to seek a relation between ejaculatory rate and the type of neurogenic bladder hyperactive or areflexive. Material/patients and methods Monocentric retrospective analysis of 22 men with a lumbosacral spinal cord injuries of neurological level varying from L1 to S5. Six men (27.3%) had complete lesions and 16 men (72.7%) had incomplete lesions. Data were collected from retrospective medical files. Every patient answered questions on sexual function. A clinical examination was also realized, including an evaluation of perineal, cremasteric, patellar and Achilles reflexes and anal testing. Urodynamics were analyzed to identify the type of neurogenic bladder, either hyperactive or areflexive. Results Fifteen out of 22 men (68.2%) maintained ejaculation with masturbation or during sexual intercourse. In this 15 men, compared to pre-injury, 4 men (26.7%) described their ejaculation as normal, 3 (20%) described it as dribbling, 2 (13.3%) described it as premature and dribbling, 2 (13.3%) described it as spontaneous triggered with psychogenic stimulation, 1 (6,6%) describe it as premature, 1 (6.6%) described it as spontaneous and dribbling, 1 man (6.6%) found that his ejaculation was delayed and 1 man (6,6%) mentioned having retrograde ejaculations. Ejaculation was preserved in 11 of the 13 subject (84.6%) with areflexive bladder whereas ejaculation was preserved in 4 of the 7 subject (57.1%) with overactive bladder. Discussion–conclusion Our results show that ejaculation is often preserved in the lumbosacral lesions compared to the general population of men with spinal cord injury. The results also show the presence of premature and dribbling ejaculations appearing after the spinal lesion, and which are in contrast with the usual lack of ejaculation reported in men with spinal cord injury. However, there are different characteristics of ejaculation ranging from the anejaculation to premature ejaculation and clinical or urodynamic examination do not predict the type of ejaculation.
Available online at
ScienceDirect www.sciencedirect.com
SCI fertility
Oral communications CO068
Intracavernous injections in spinal cord injured men with erectile dysfunction, a systematic review and meta-analysis Lucie Chochina 1,∗ , Florian Naudet 3 , Isabelle Bonan 1 , Clément Chehensse 1 , Mireille Damphousse 1 , Andrea Manunta 2 , Franc¸ois Giuliano 4 1 CHU de Rennes, MPR, Rennes, France 2 CHU Pontchaillou, urologie, Rennes, France 3 CHU Pontchaillou, pharmacologie, Rennes, France 4 Hopital R.-Poincaré, urologie, Garches, France ∗ Corresponding author. E-mail address: [email protected] (L. Chochina) Objective To review the efficacy of intracavernous injections (ICI) in spinal cord injured (SCI) men and to identify prognostic factors affecting the efficacy of ICI in this population. Material/patients and methods Systematic review of the literature using 5 databases. Articles published up to november 2014 using the keywords: alprostadil; papaverine; moxisylyte; alpha-blocking agent; phentolamine; intracavernous injection; spinal cord injuries; paraplegia; quadriplegia; erectile dysfunction; were included. Results Twenty-three studies were included (713 SCI patients). ICIs resulted in successful erections in 88% of patients. Erections were obtained respectively in 93% of patients with the combination of papaverine and phentolamine, in 91% with papaverine alone and in 80% with prostaglandin E1. The statistical analysis could not identify specific factors predictive of response to ICI. Discussion–conclusion ICIs are an effective treatment of erectile dysfunction in SCI men. No predictive factor for efficacy could be identified. Studies comparing the response to ICI in upper and lower motor neuron lesions could improve our understanding of ICI failure. CIs are an effective treatment of erectile dysfunction in SCI men. No predictive factor for efficacy could be identified. Studies comparing the response to ICI in upper and lower motor neuron lesions could improve our understanding of ICI failure. Keywords Paraplegia; Quadriplegia; Erectile dysfunction; Alprostadil; Papaverine Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2016.07.237
1877-0657/
CO069
Ejaculation in men living with a lumbosacral spinal cord injury. Retrospective study of 22 subjects Damien Waz 1,∗ , Kathleen Charvier 2 Hôpital Pierre-Wertheimer, SRPR, Bron, France 2 Hôpital Henry-Gabrielle, rééducation neuropérinéale et sexologique, Saint-Genis-Laval, France ∗ Corresponding author. E-mail address: muse [email protected] (D. Waz)
1
Objective The goal is to characterize the ejaculation rate and the type of ejaculation experienced by men living with a lumbosacral spinal cord injury. The secondary objective is to seek a relation between ejaculatory rate and the type of neurogenic bladder hyperactive or areflexive. Material/patients and methods Monocentric retrospective analysis of 22 men with a lumbosacral spinal cord injuries of neurological level varying from L1 to S5. Six men (27.3%) had complete lesions and 16 men (72.7%) had incomplete lesions. Data were collected from retrospective medical files. Every patient answered questions on sexual function. A clinical examination was also realized, including an evaluation of perineal, cremasteric, patellar and Achilles reflexes and anal testing. Urodynamics were analyzed to identify the type of neurogenic bladder, either hyperactive or areflexive. Results Fifteen out of 22 men (68.2%) maintained ejaculation with masturbation or during sexual intercourse. In this 15 men, compared to pre-injury, 4 men (26.7%) described their ejaculation as normal, 3 (20%) described it as dribbling, 2 (13.3%) described it as premature and dribbling, 2 (13.3%) described it as spontaneous triggered with psychogenic stimulation, 1 (6,6%) describe it as premature, 1 (6.6%) described it as spontaneous and dribbling, 1 man (6.6%) found that his ejaculation was delayed and 1 man (6,6%) mentioned having retrograde ejaculations. Ejaculation was preserved in 11 of the 13 subject (84.6%) with areflexive bladder whereas ejaculation was preserved in 4 of the 7 subject (57.1%) with overactive bladder. Discussion–conclusion Our results show that ejaculation is often preserved in the lumbosacral lesions compared to the general population of men with spinal cord injury. The results also show the presence of premature and dribbling ejaculations appearing after the spinal lesion, and which are in contrast with the usual lack of ejaculation reported in men with spinal cord injury. However, there are different characteristics of ejaculation ranging from the anejaculation to premature ejaculation and clinical or urodynamic examination do not predict the type of ejaculation.