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
- 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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