Effect of Oral Sildenafil Citrate (Viagra(R)) in Erectile Dysfunction Following Spinal Cord Injury

OBJECTIVE: To evaluate the effect of oral sildenafil citrate (Viagra(R)) on erectile dysfunction following spinal cord injury. METHOD: Seventy nine male patients with erectile dysfunction after spinal cord injury, who were free from contrain dications, received 50 mg of sildenafil. Visual-analogue erection scale (VAES) was used to evaluate the rigidity of penis before and after the medication. In addition, the duration of erection and side effects of sildenafil were evaluated. RESULTS: Mean VAES score showed a statistically significant increase after the medication from 5.6 to 7.5 (p=0.000). The mean duration of erection also increased from 3.4 minutes to 27.1 minutes after medication (p=0.000). Sixty seven patients (84.8%) reported improved erection with 50 mg of sildenafil and sixty one patients (77.2%) reported rigid erection enough for sexual intercourse. Ten patients (12.7%) reported side effects: facial flushing (3), dizziness (2), headache (2), chest pain (2), and palpitation (1). CONCLUSION: This study demonstrated that sildenafil is an effective medication in treating erectile dysfunction after spinal cord injury.

Measurement of the Steering Torque in Cervical Cord Injured Persons Using BTE Work Simulator

OBJECTIVE: To evaluate the standards of handicapped driver's ability test in Korea and available driving aids in cervical cord injured persons. METHOD: Forty-two cervical cord injured persons (C5~C8) were evaluated with BTE (Baltimore Therapeutic Equipment) work simulator. The isotonic turning torque was measured during clockwise and counter-clockwise turning. And isometric turning torque was measured at 12 directions. RESULTS: By the isotonic measurement, the turning torque increased in the lower level of injury. In the C6 tetraplegics, the counter-clockwise turning torque was significantly higher than clockwise. Among 25 persons with C5 or C6 tetraplegia, only 2 with C6 tetraplegia could operate the power steering with the lowest wheel turning torque (3.0 Nm). Only three persons (1 person with C7 tetraplegia, 2 persons with C8 tetraplegia) could pass the handicapped driver's ability test of Korea (9.4 Nm). By the isometric measurement, turning torque was lowest at left upper quadrant (10 to 12 o'clock direction) in clockwise rotation. CONCLUSION: Among the 42 cervical cord injured persons, only 3 persons with C7 and C8 tetraplegia could pass the handicapped driver's ability test of Korea. And among 25 C5 and C6 tetraplegia, only 2 persons with C6 tetraplegia could operate the power steering. It seems to be essential to modify the standards of handicapped drivers ability test and to evolve the driving aids for the C5 and C6 tetraplegics in Korea.

The Effect of Functional Electrical Stimulation on Hemiplegic Shoulder Subluxation

OBJECTIVE: The purpose of this study is to evaluate the effect of functional electrical stimulation (FES) on hemiplegic shoulder subluxation in post-acute stroke patients. METHOD: Forty-four patients who had shoulder subluxation as a consequence of their first stroke were included and randomly assigned to either a control group (22 subjects) or a study group (22 subjects). Patients in both groups received physiotherapy and used an arm sling. The study group received, FES therapy to shoulder muscles (supraspinatus and posterior deltoid) for 30 minutes, five days a week for 6 weeks. The effect of FES therapy was evaluated by assessment of the severity of subluxation using radiologic measurements before and after treatment. RESULTS: 1) The severity of subluxation was significantly increased after 6 weeks (p0.05). 2) In the group of patients with early treatment (onset duration, less than 6 months), the control group showed a significant increase in subluxation (p<0.05), but the study group showed significantly reduced (p<0.05) shoulder subluxation after treatment period. 3) In the group of patients with mild shoulder subluxation before treatment (less than 1 finger breadth), the control group showed a significant increase in subluxation (p<0.05), but the study group showed significantly reduced (p<0.05) shoulder subluxation after treatment period. CONCLUSION: The FES therapy is effective in preventing and reducing the severity of hemiplegic shoulder subluxation in post-acute stroke patients, especially if duration since stroke onset was less than six months and the severity of subluxation before treatment was mild.

The Erectile Response to Intracavernosal Injection of Prostaglandin E1 in Spinal Cord Injured Men

OBJECTIVE: To study the erectile response to intracavernosal injection of prostaglandin E1 in 33 spinal cord injured men with neurogenic erectile dysfunction. METHOD: The erectile response was assessed by the penile palpation. Thirty three subjects (mean age, 35.5 years) were studied. They received a testing dosage starting from 2.5 microgram with increasing dosage (maximum 40 microgram) to achieve an erection. The positive response accounts for the sufficient erection lasting for more than 30 minutes. RESULTS: After the injection, 30 subjects (90.9%) achieved the positive response and the mean duration of erection was 59.2 minutes. Of the 30 positive responders, the mean dosage needed to induce positive response was 5.8 microgram in the patients with cervical cord injury (12 subjects), 13.1 microgram in the patients with thoracic cord injury (12 subjects), and 33.3 microgram in the patients with lumbar cord injury (6 subjects). The mean dosage required for the positive response was different according to the pre-injection erectile function of the subjects. For the positive response, it required 7.7 microgram in a full erection with short duration group (14 subjects), 9.4 microgram in a partial erection group (8 subjects), and 30.6 microgram in no erection group (8 subjects). No systemic side effect or complication was noted except for the prolonged erection in 1 subject. CONCLUSION: The intracavernosal injection of prostaglandin E1 appears to be a safe and effective treatment for the treatment of erectile dysfunction in spinal cord injured men. The dosage depends on the level of spinal cord injury and pre-injection erectile function.

A Follow-up of Neurogenic Bladder in Patients with Spinal Cord Injury

OBJECTIVE: The purposes of this study were 1) to evaluate the effectiveness of follow-up urologic evaluation of neurogenic bladder in patients with spinal cord injury, 2) to define risk factors causing upper urinary tract complications, and 3) to evaluate changes of the vesicoureteral reflux grade on follow-up study. METHOD: Urodynamic studys, ultrasonographys, and voiding cystourethrographys of 90 patients with spinal cord injury who admitted to the bladder clinic of National Rehabilitation Hostpital were evaluated. Of the 90 patients, twenty four patients (27%) had upper urinary tract complication (vesicoureteral reflux or hydronephrosis). The risk factors of upper urinary tract complication were compared. The patients who had vesicoureteral reflux were devided into two main groups: conservative medical treatment group (oxybutynin, atropine intravesical instillation and intermittent catheterization) and primary surgical treatment group, and then the changes of the vesicoureteral reflux grade on follow-up study were evlauated. RESULTS: 1) The incidence of upper urinary tract complication was 27% for all patients. After bladder clinic evaluation, the patients who were recommended the change of the voiding mothods were 24%, and 58% of the patients were need management to decrease maximal detrusor pressure. 2) Maximal bladder capacity by clinical voiding chart recording ( or =trabeculation grade 2), leak point pressure (> or =40 cmH20), and maximal detrusor pressure (> or =90 cmH2O) were significantly different between patients with upper urinary tract complication and patients without that. 3) In the eight vesicoureteral reflux patients, five of six patients were cured or improved with conservative treatment and two patients were cured with surgical treatment. CONCLUSION: The periodic follow-up evaluation of neurogenic bladder of spinal cord injuredpatients was important to prevent upper urinary tract deterioration. The factors related upper urinary tract complication were clinical bladder capacity, leak point pressure, bladder wall deformity (trabeculation) and maximal detrusor pressure.