Beyond the Abstract - Cell phones and male infertility: A review of recent innovations in technology and consequences, by Alaa J. Hamada, MD (2)

BERKELEY, CA (UroToday.com) - Rehabilitation medicine, particularly rehabilitation of individuals with spinal cord injury (SCI) is a team’s work.

While various professionals provide treatments for different aspects of SCI, these treatments may have undue or unknown interactions with each other. In recent years, urology and physical medicine have introduced treatments with botulinum toxin (BT) to alleviate overactive bladder, bladder-sphincter dyssynergia, spasticity and pain. While BT injections have been found to be effective for these conditions, their effect on the reproductive system and sexual function have been under-investigated, especially in men with SCI. Knowing that men represent 75 percent of the SCI population and knowing that SCI men are generally in their twenties, sexual function is a major aspect of their disability and is reported as a priority for quality of life.

The beneficial and/or detrimental effect of intradetrusor BT injections on the ejaculation potential and fertility of men with SCI, who receive BT treatment for their hyperactive bladder, is not known. Diffusion of BT injections, in contrast, is a known fact, and while the drug paralyzes the detrusor muscle, it may also paralyze the muscular envelopes of adjacent reproductive organs through diffusion. BT injections may therefore yield negative side effects on sexual and reproductive function, despite their beneficial effects on bladder function. Our recent study addressed this question by assessing the clinical data of patients with SCI who received BT injections for their overactive bladder, but who were also consulting for fertility. The data provides preliminary evidence on the potential negative side effects of BT injections on semen volume and retrograde ejaculation, but also potential beneficial effects on semen quality. Eleven patients with complete lesions to the spinal cord (varying from C5 to T6) consulted for fertility and had undergone ejaculation tests before and after receiving BT treatment. The data confirmed that BT injections were effective in improving bladder function, but suggested that they increased the incidence of retrograde ejaculation and decreased the volume of semen ejaculated. While the results may have negative effects on men’s sexual confidence, through a misperceived loss of ejaculation (when ejaculation is retrograde) or a drop in ejaculation volume, BT treatment appears to improve the quality of semen. Semen culture was improved and sperm mobility and vitality increased following BT treatment. The negative effect of BT injections on ejaculation and sexual function may therefore be counterbalanced with the improvement of fertility in men with SCI. These data, although preliminary and on a small sample, suggest that the diffusion of BT injections can spread to the bladder neck and reduce its tonus, thereby opening the route to retrograde ejaculation. It may also spread to adjacent smooth muscles surrounding the sexual accessory organs and reduce the strength of their contraction, thereby reducing the volume of semen ejaculated. On the positive side however, BT injections may reduce the rate or severity of urinary infections in men with SCI and reduce contamination of the semen with bacteria, thereby improving spermatogenesis and semen quality (and perhaps reducing the risk of prostatic infection and orchitis).

These preliminary data suggest that men with SCI should be informed on the potential impact of BT injections on sexual and reproductive function.

 

Written by:
Courtois Frédérique, Caremel Romain, Charvier Kathleen, Ruffion Alain, and Morel Journel Nicolas as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

 

Side effects of intradetrusor botulinum toxin injections on ejaculation and fertility in men with spinal cord injury: Preliminary findings - Abstract

UroToday.com Male Infertility and Reproduction Section

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