title: The choice of assisted ejaculation method is relevant for the diagnosis of azoospermia in men with spinal cord injuries.
abstract: METHODS
  Retrospective analysis of research data collected over >18 years at our center.
  
  
  OBJECTIVE
  Examine results of repeated semen retrievals in men with spinal cord injury (SCI) who were initially found to be azoospermic.
  
  
  METHODS
  Major university medical center.
  
  
  METHODS
  Three different groups were analyzed in this study. Group 1 (n = 15) consisted of patients who were found to be azoospermic after the first ejaculation obtained by penile vibratory stimulation (PVS) and who had subsequent ejaculates obtained by PVS. Group 2 (n = 8) consisted of patients who were found to be azoospermic after the first ejaculation obtained by PVS and who had subsequent ejaculates obtained by electroejaculation (EEJ). Group 3 (n = 18) consisted of patients who were found to be azoospermic after the first ejaculation obtained by EEJ and who had subsequent ejaculates obtained by EEJ.
  
  
  RESULTS
  In group 1 (PVS-PVS), the second ejaculate contained sperm in none of the 15 patients. In group 2 (PVS-EEJ), the second ejaculate contained sperm in three of eight patients. In group 3 (EEJ-EEJ), the second EEJ resulted in semen with sperm in 6 of 18 patients. In the 388 study subjects, the overall prevalence of azoospermia was 7.0%.
  
  
  CONCLUSIONS
  In a study of a large group of subjects with SCI, the vast majority had normal sperm concentrations. In the minority who were azoospermic on their first ejaculate, and who were past the acute phase of injury, obtaining a second ejaculate by EEJ versus PVS may be a reasonable step before proceeding to surgical sperm retrieval.
authors.affiliation: The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: V
authors.initials: V
authors.lastname: Iremashvili
authors.forename: N L
authors.initials: NL
authors.lastname: Brackett
authors.forename: E
authors.initials: E
authors.lastname: Ibrahim
authors.forename: T C
authors.initials: TC
authors.lastname: Aballa
authors.forename: C M
authors.initials: CM
authors.lastname: Lynne
mesh_terms: D053713:Azoospermia / Q000175:diagnosis* / Q000209:etiology; D004542:Ejaculation / Q000502:physiology*; D007172:Erectile Dysfunction / Q000175:diagnosis / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D026741:Physical Therapy Modalities / Q000592:standards; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications* / Q000175:diagnosis / Q000534:rehabilitation