Repetitive Tests and Association Midodrine-Penile Vibratory Stimulation Help to Preserve Fertility in Spinal Cord Injury Patients: Results from a Cohort of 86 Patients

Ejaculation disorders are common in Spinal Cord Injury (SCI) patients and require often samples to preserve their fertility potential. The means to obtain ejaculation depend on the neurological level and the experience of the team. We reviewed the results of our cohort, the means used, particularly the benefits of adding Midodrine or penile vibratory stimulation (PVS) to obtain the sample. We collected retrospectively in our cohort of patients the epidemiological data, the type of ejaculation (anterograde or retrograde) and the means used to obtain a frozen sample of sperm. We compared the data of two groups: those who obtained an anterograde ejaculation (AE) and those only a retrograde (ER). Between January 2013 and July 2017, 86 patients were seen in consultation, with a mean age of 30 years, mainly after traumatic injury (90%), cervico-thoracic level (89%) and complete lesion (59%). Ejaculation was not obtained in 13 patients (15%): 7 (8%) were considered to be failing, 4 had dropped out of care, and 2 were starting treatment. AE and RE were obtained in 73 patients (85%), which could be frozen in 63 patients (73%) mainly from an EA for 47 patients. Only 9 patients were able to obtain their sperm by self-stimulation, the other 54 needed to use single or double PVS associated or not with Midodrine. In the only ER group, predominantly patients with complete deficiency below T10, the dose of Midodrine, the number of trials and the frequency of use of double PVS were more important than in the EA group (respectively 23.5 mg vs 9 mg, 3 vs 1.8, 64 vs 29%). In SCI patients for whom it is difficult to obtain an ejaculation, it's fundamental to look for ER, repeat the tests, aided by increasing dose Midodrine and PVS.