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Urethral pressure profile during ejaculation in men with spinal cord injury

International Journal of Impotence Research volume 35, pages 1–7 (2023)Cite this article

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Abstract

Ejaculation is often impaired in men with spinal cord injury (SCI). The aim of this prospective study was to assess sequence of sphincteric events and ejaculation dyssynergia during penile vibratory stimulation (PVS) in SCI men. Simultaneous recordings of bladder, bladder neck, prostate and external urethral sphincter pressures were performed using a microtip catheter with 5 pressure transducers. Between 2017 and 2019, ten men participated in the study for a total of 17 procedures. Antegrade ejaculation was found in three men with upper motor neuron (UMN) lesion. Ejaculation was preceded by a progressive increase in all urethral pressures, reaching sustained (plateau) or intermittent peaks above 220 cm H20. Antegrade ejaculation occurred after intermittent decreases in pressure at the external urethral sphincter level down to 100 cm H20, while the pressure at the bladder neck remained high (up to or above 220 cm H20). PVS was ineffective in eliciting ejaculation in seven men. In the five patients with UMN lesions, PVS elicited an increase in the external urethral sphincter pressure (mean 51 cm H20), while there was no pressure change in the two patients with lower motor neuron lesions. Due to lack of enough retrograde retrieval attempts, the hypothesis of ejaculatory dyssynergia could not be verified.

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Fig. 1: Schematic representation of the location of the sensors in the urethra.
Fig. 2: 3-min PVS cycle in a man with UMN lesion, without ejaculation.
Fig. 3: 3-min PVS cycle in a man with LMN lesion, without ejaculation.
Fig. 4: Pressure profile during PVS-induced ejaculation in a man with UMN lesion.

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Acknowledgements

The authors are grateful to Stéphane Verdun, Sahara Graf, and Linda Zoniaba (Delegations for Clinical Research and Innovation, Lille Catholic Hospitals, Lille Catholic University, Lille, France) for methodological and statistical assistance.

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Authors and Affiliations

  1. Spinal Unit, Centre Calve, Fondation Hopale, Berck-sur-Mer, France

    Jean-Gabriel Previnaire

  2. Centre Bouffard Vercelli, 66000, Perpignan, France

    Jean-Marc Soler

  3. Delegations for Clinical Research and Innovation, Lille Catholic Hospitals, Lille Catholic University, Lille, France

    Melody Plets

  4. Neuro-Uro-Andrology, R. Poincare Academic Hospital, AP-HP, 104 bvd R. Poincare, 92380, Garches, France

    Pierre Denys & François Giuliano

  5. Faculty of Medicine, Versailles Saint Quentin University, UMR Inserm 1179, Paris Saclay, 78180, Montigny le Bretonneux, France

    Pierre Denys & François Giuliano

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  1. Jean-Gabriel Previnaire
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  4. Pierre Denys
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  5. François Giuliano
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Contributions

JGP, JMS, MP, PD, and FG conceived the work that led to the submission; drafted and revised the manuscript; and approved the final version. JGP acquired data. JGP, JMS, MP, PD, and FG agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved, JGP has had full access to the data in the study and final responsibility for the decision to submit for publication

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Correspondence to Jean-Gabriel Previnaire.

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Previnaire, JG., Soler, JM., Plets, M. et al. Urethral pressure profile during ejaculation in men with spinal cord injury. Int J Impot Res 35, 1–7 (2023). https://doi.org/10.1038/s41443-022-00527-x

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