title: Ejaculation and sperm characteristics in men with cauda equina and conus medullaris syndromes.
abstract: METHODS
  Retrospective.
  
  
  OBJECTIVE
  The objective of the study was to describe the type of ejaculation in patients with cauda equina (CE) and conus medullaris (CM) lesions, and to analyse sperm quality.
  
  
  METHODS
  France.
  
  
  METHODS
  One hundred sixty-six patients with CE and CM lesions were included. Diagnosis was based on clinical (no motor responses, sensation or sacral reflexes) and urodynamic assessments (no detrusor activity). Vibromassage (VM) was used to induce ejaculation according to the recommendations for patients with spinal cord injury. If ejaculation did not occur, oral midodrine was administered in progressive doses. Retrograde ejaculation was systematically sought. Sperm parameters were analysed according to World Health Organisation recommendations (2010).
  
  
  RESULTS
  Eighty-nine patients were included. Eleven ejaculated on the first VM trial (four anterograde (AE), six retrograde (RE) and one antero-retrograde (ARE)). Five patients continued trials of VM alone, two of whom ejaculated following a mean 1.9 trials (one RE, one ARE). Twenty-six patients underwent trials of VM+ midodrine, 18 of whom ejaculated following a mean 4.4 trials with a mean dose of 22.5 g of midodrine (2 AE, 13 RE and 5 ARE). Fifty-three ejaculates from 26 patients were analysed. Sperm concentration was low in 90.6% of samples; total necrospermia was found in 65% and asthenospermia in 95% of samples.
  
  
  CONCLUSIONS
  Ejaculation is difficult to induce using VM in patients with CE and CM lesions, and requires high doses of midodrine. Sperm counts were generally low, and asthenospermia and necrospermia were found in the majority of specimens. Cryopreservation of sperm should be systematic in case of medically assisted procreation.
authors.affiliation: Laboratoire de neuro-urologie et de sexologie, Centre Bouffard-Vercelli, Cerbère, France.
authors.forename: N
authors.initials: N
authors.lastname: Hadiji
authors.affiliation: Médecine de la reproduction, Hôpital Paule de Viguier, Toulouse, France.
authors.forename: R
authors.initials: R
authors.lastname: Mieusset
authors.affiliation: Département Médullaire, Centre Calvé-Fondation Hopale, Berck-Sur-Mer, France.
authors.forename: J G
authors.initials: JG
authors.lastname: Previnaire
authors.affiliation: Médecine de la reproduction, Hôpital Paule de Viguier, Toulouse, France.
authors.forename: E
authors.initials: E
authors.lastname: Castel-Lacanal
authors.affiliation: Laboratoire de neuro-urologie et de sexologie, Centre Bouffard-Vercelli, Cerbère, France.
authors.forename: J M
authors.initials: JM
authors.lastname: Soler
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D004542:Ejaculation / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008879:Midodrine / Q000008:administration & dosage; D011128:Polyradiculopathy / Q000473:pathology* / Q000503:physiopathology*; D012189:Retrospective Studies; D013076:Sperm Count; D013081:Sperm Motility; D013094:Spermatozoa / Q000473:pathology / Q000502:physiology; D013117:Spinal Cord Compression / Q000473:pathology* / Q000503:physiopathology*; D013566:Sympathomimetics / Q000008:administration & dosage; D014732:Vibration; D055815:Young Adult
chemical_list: D013566:Sympathomimetics; D008879:Midodrine