ERECTILE DYSFUNCTION IN SPINAL CORD INJURY - DNB Orthopaedics MS Orthopedics MRCS Exam GUIDE - Orthodnb.com

DNB Orthopaedics  MS Orthopedics  MRCS Exam GUIDE - Orthodnb.com

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Wednesday, 4 April 2018

ERECTILE DYSFUNCTION IN SPINAL CORD INJURY

ERECTILE DYSFUNCTION IN SPINAL CORD INJURY

  • erection and ejaculation are under autonomic control
    • erection : parasympathetic
    • ejaculation : sympathetic
  • erection – segmental reflex – located in sacral spinal cord – controlled by higher CNS centers
    • primary pathway : sacral parasympathetic outflow
    • secondary pathway : thoracolumbar sympathetic outflow – essential for the control of corpus spongiosum and glans penis – clinically preservation confirmed by presence of testicular sensation
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  • lesions below T12
    • psychogenic erection preserved
    • respond to sexual fantasy
  • lesion above T12
    • need penile stimulation to achieve erection
    • do not respond to visual stimuli – only reflex erection preserved
Treatment

  • Sildenafil
    • phosphodiesterase 5 inhibitor
    • 50mg
    • efficacy depends on sparing of either sacral or thoracolumbar (T10-L2) spinal segments
    • thoracolumbar or sympathetic outflow is important for psychogenic erection and must be intact for Sildenafil to be effective
  • Vacuum erection devices
  • penile prosthesis
  • sperm recovery after cord injury
    • vibratory stimulation
    • electro ejaculation
      • directly stimulating nerves with electrical probe placed in rectum
    • surgical sperm retrieval
      • Microsurgical Epididymal Sperm Aspiration (MESA)
      • Percutaneous Epididymal Sperm Aspiration (PESA)
      • Testicular Sperm Extraction (TESE)
      • Percutaneous Testicular Sperm Aspiration (PTSA)

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