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Chapter 17 - Andrological Care of the Patient with Spinal Cord Injury

from Section 3 - Clinical Evaluation and Treatment of Male Infertility

Published online by Cambridge University Press:  06 December 2023

By
Christian Fuglesang S. Jensen ,
Jens Sønksen  and
Dana A. Ohl
Edited by
Douglas T. Carrell ,
Alexander W. Pastuszak  and
James M. Hotaling
Douglas T. Carrell
Affiliation:
Utah Center for Reproductive Medicine
Alexander W. Pastuszak
Affiliation:
University of Utah
James M. Hotaling
Affiliation:
Utah Center for Reproductive Medicine
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Summary

Men with spinal cord injury often suffer from erectile dysfunction, ejaculatory dysfunction, infertility, and hypogonadism. Restoration of sexual and reproductive functions is a top priority and efficient treatment modalities exist. Erectile dysfunction can be treated with phosphodiesterase-5 inhibitors and if unsuccessful intracavernosal injections can be tried. When injections fail a penile implant can ultimately be an option. Anejaculation and the resulting infertility are treated in a stepwise approach with penile vibratory stimulation, electroejaculation and surgical sperm retrieval followed by assisted reproduction. Assisted ejaculation is an effective and safe procedure but carries a risk of autonomic dysreflexia, especially in men with injuries at the level of T6 or above. Autonomic dysreflexia is an unregulated and uncontrolled response of the sympathetic nervous system but it can be safely managed. Hypogonadism is more prevalent in men with spinal cord injury compared to the general population and testosterone replacement therapy can be beneficial for alleviating symptoms of low testosterone, but testosterone-related spermatogenic suppression needs to be considered in men who wish to initiate a pregnancy.

Keywords

SCImen’s healtherectile dysfunctionhypogonadismlow Telectrostimulated ejaculationSCI reproductionsexual function
Type
Chapter
Information
Men's Reproductive and Sexual Health Throughout the Lifespan
An Integrated Approach to Fertility, Sexual Function, and Vitality
 , pp. 135 - 140
Publisher: Cambridge University Press
Print publication year: 2023

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References

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