BERKELEY, CA (UroToday.com) - Spinal cord injury (SCI) remains a prevalent disease with 12 000 new cases per year, and young males comprise the majority of this population. As with many young men, those with SCI often desire paternity in their lifetimes. Alongside erectile dysfunction and poor semen quality, anejaculation is a continued concern in this group, with only 10% able to ejaculate by masturbation.[2, 3] First-line therapy for anejaculation in men with SCI is penile vibratory stimulation (PVS).
PVS requires premedication to prevent autonomic dysreflexia in patients whose level of injury is T6 or rostral. PVS is more effective in patients whose level of injury is rostral vs caudal to T10, owing to preservation of the ejaculatory reflex arc. The efficacy of PVS for men with SCI has undergone an evolution over the past two decades. Initial penile vibrators were lower amplitude vibrators which have since been proven to be less efficacious than newer “high amplitude” vibrators. Evidence shows that that “sandwiching” the penis between two vibrators can salvage failures to one vibrator.
The current study focused on a new penile vibratory stimulator, the Viberect-X3® (Reflexonic, Frederick, MD, USA). The Viberect® (Reflexonic, Frederick, MD, USA) was first introduced as a device aimed at penile rehabilitation in patients with erectile dysfunction. It differed from traditional penile vibrators in that it had two vibrating surfaces which could be applied simultaneously to the dorsum and frenulum of the glans penis. The Viberect-X3® has a higher amplitude than the Viberect® and was developed to induce ejaculation in men with SCI. The Viberect-X3® is the device studied here. Our results showed the Viberect-X3® to be safe in all 30 men with SCI involved in this study, and effective in 77% (23/30).
In patients with SCI, fertility is often an important topic for counseling. PVS is a first-line therapy for anejaculation in men with SCI and the Viberect-X3® provides an additional option for PVS. We are currently performing studies to directly compare the Viberect-X3® with other methods of PVS in order to identify appropriate candidates for the various methods of PVS.
The goal of our studies is to maximize reproductive options in this severely affected population. PVS has been shown to result in higher yields of total motile sperm compared to surgical sperm retrieval. Increased numbers of total motile sperm may allow the couple to consider lower cost and less invasive assisted conception procedures such as intrauterine insemination, or even intravaginal insemination, instead of the relatively more expensive and invasive option of in vitro fertilization combined with intracytoplasmic sperm injection. This latter option is typically required when sperm are retrieved surgically from the testis or epididymis, owing to the low numbers of motile sperm obtained with surgical methods.
We encourage practitioners to try PVS for sperm retrieval in anejaculatory patients with SCI. Detailed information about administration of PVS can be found in previous publications.[6, 7]
- National SCI Statistical Center. Spinal Cord Injury - Facts and Figures at a Glance 2013. https://www.nscisc.uab.edu/PublicDocuments/fact_figures_docs/Facts%202013.pdf
- Brown DJ, Hill ST, Baker HW. Male fertility and sexual function after spinal cord injury. Prog Brain Res 2006; 152:427-439.
- Brackett NL, Lynne CM, Ibrahim E, Ohl DA, Sonksen J. Treatment of infertility in men with spinal cord injury. Nat Rev Urol 2010; 7:162-172.
- Brackett NL, Kaetsoulis A, Ibrahim E, Aballa TC. Application of 2 vibrators salvages ejaculatory failures to 1 vibrator during penile vibratory stimulation I men with spinal cord injuries. J Urol 2007; 177:660-663.
- Castle SM, Jenkins LC, Ibrahim E, Aballa TC, Lynne CM, Brackett NL. Safety and Efficacy of a New Device for Inducing Ejaculation in Men with Spinal Cord Injuries. Spinal Cord 2014; Aug; 52 Supp 2:S27-9
- Brackett NL, Lynne CM, Sonksen J, Ohl DA. Penile vibratory stimulation. In: Surgical and Medical Management of Male Infertility. M Goldstein, P Schlegel, (Eds.), Cambridge University Press, NY, 119-129, 2013.
- Brackett NL, Ibrahim E, Iremashvili VV, Aballa TC, Lynne CM. Treatment of ejaculatory dysfunction in men with spinal cord injury: an 18-year single-center experience. J Urol, 183(6): 2304-2308, 2010.
Scott M. Castle, MD, Charles M. Lynne, MD, Emad Ibrahim, MD and Nancy L. Brackett, PhD, HCLD 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.
The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL USA
Address for correspondence:
Nancy L. Brackett, Ph.D., HCLD
Professor of Neurological Surgery and Urology
University of Miami Miller School of Medicine
The Miami Project to Cure Paralysis; Lois Pope Life Center, Room 1-27
1095 NW 14th Terrace
Miami, FL 33136 USA