[Intracavernous injections in the treatment of erectile dysfunction in spinal cord injured patients: experience with 36 patients]. / Utilisation des injections intracaverneuses dans les dysfonctionnements érectiles du blessé médullaire : à propos d'une expérience sur 36 patients.

OBJECTIVES: To confirm the efficiency of intracavernous injections in the treatment of erectile dysfunction in spinal cord injured (SCI) patients and to determine the mean necessary dose to obtain functional erection. MATERIALS: This prospective study concerns 36 spinal cord injured men. None of them had erectile dysfunction before the neurologic impairement. Sixty four intracavernous injections were performed. METHOD: The first injection was done with the usually recommended starting dose. The injections were then repeated with increasing dosage to archive a rigid erection. The erection was evaluated with Schramek grading. A grade 4 or 5 erection was considered as functional. RESULTS: Nine tetraplegics and 27 paraplegics were included. Twenty two were grade A in ASIA classification. The mean age was 31 years. Twenty for patients had a level above T10, 11 between T11 and L2, one below L2. Twenty seven patients obtained an erection of grade 4 or 5. Alprostadil was used 51 times, moxisylite nine times and papaverine four times. The average dose necessary to obtain a grade 4 or 5 functional erection adequate for coitus was 12.3 +/- 4.8 microgram with alprostadil and 14 +/- 5.4 mg with moxisylite. No side effects were noted. The nine left patients did not archive satisfying erection during this study. No clinical differences were noted in this population, compared with the 27 other patients. CONCLUSION: The findings confirm the efficiency of intracavernous injections in the management of erectile dysfunction in SCI. The average doses required to obtain a functional erection was 12.3 (+/- 4.8) microgram with alprostadil and 14 (+/- 5.4) mg with moxisylyte.

Effects of intrathecal clonidine injection on spinal reflexes and human locomotion in incomplete paraplegic subjects.

We studied the effect of the intrathecal (i.t.) injection of clonidine (30, 60 and 90 microg) on the polysynaptic spinal reflexes (PSR) elicited by electrical stimulation of flexor reflex afferents (FRA), monosynaptic reflex and gait of 11 subjects with spinal cord injuries. The effect of clonidine administration on gait velocity, stride amplitude and duration was measured in eight subjects who were able to walk. Five subjects were able to walk after intrathecal injection of clonidine and three were not able to stand up. Three subjects improved their gait velocity after clonidine administration; one (S6) increased his stride amplitude; the two others decreased their cycle durations. The tibialis anterior seemed to be more regularly activated during gait. Spasticity was reduced dramatically (P<0.0001) after i.t. clonidine injection, but there was no statistically significant difference in the soleus H reflex (no effect on Hmax/Mmax). Clonidine administration decreased the amplitude of the early PSR (90-120 ms, N=4) and the threshold and maximal integrated EMG corresponding to the late response (140-450 ms, N=7). This effect was dose dependent (30, 60 and 90 microg). Placebo injection (N=4) caused no change. The changes in spinal reflexes, with a large reduction in spasticity, no change in motoneurone excitability and a large decrease in PSR, suggest that clonidine acts at a premotoneuronal level, possibly by presynaptic inhibition of group II fibres. The increase in gait velocity in three subjects could have been due to reduced spasticity or activation of spinal circuitry.

[Urologic complications of multiple sclerosis. 180 cases]. / Les complications urologiques de la sclérose en plaques. 180 cas.

OBJECTIVES: The aim of this study was to assess frequency and importance of urological complications in multiple sclerosis. METHODS: A total of 180 patients with multiple sclerosis (115 women, 64 men; mean disease duration 13.4 years) underwent the following examinations: neuroperineal examination, bladder and kidney echography, intravenous pyelography, creatinine assay, urodynamic investigation and sphincter electromyography. RESULTS: Detrusor hyperreflexia (70%) and areflexia (15%) were the commonest findings on cystometry and correlated with clinical data (urinary incontinence in 62% and retention in 18%). Urologic complications were noted in 56% with benign lesions in 37% (diverticula, urinary infections) and serious lesions in 19% (hydronephrosis, pyelonephritis, renal reflux). No correlations were found between complications and dyssynergia, overactivity and urinary retention. CONCLUSIONS: The presence of these complications suggests the need for frequent urodynamic and radiologic controls in patients with multiple sclerosis.