The incidence and etiology of sperm DNA fragmentation in the ejaculates of males with spinal cord injuries.

STUDY DESIGN: Retrospective descriptive study. OBJECTIVES: To determine the incidence and probable etiology of sperm DNA fragmentation (SDF) in a sample of males with spinal cord injury (SCI). SETTING: Hospital in Toledo, Spain; University-based Genetics laboratory in Madrid, Spain. METHODS: Semen collected by vibro-stimulation from 27 males with various levels of spinal cord injury. Classical semen parameters, SDF, leukocytospermia and pro-oxidant capacity were assessed and compared with a cohort of normozoospermic fertile donors (n = 10). RESULTS: Males with SCI presented with lower semen quality compared with normozoospermic donors with respect to progressive motility (p = 0.0002), SDF (p < 0.00005), pro-oxidant capacity (p = 0.0191) and leukocytospermia (p < 0.00005). Although there was no significant correlation between semen quality and time since the lesion occurred, the period of abstinence appeared to be positively correlated with SDF (r = 0.486; p = 0.041). When the semen parameters of males with SCI were categorized based on those with cervical and thoracic lesions, sperm concentration was higher for those with cervical damage (p = 0.0257). Males with complete lesions (AIS A) had ejaculates that were lower in progressive motility (p = 0.0040) than those with incomplete injuries (AIS B-D). CONCLUSIONS: Ejaculates of males with SCI have excessively elevated SDF when compared with normozoospermic donors, which is likely to be associated with coincident high levels of leucocytospermia and pro-oxidant capacity. We propose that these phenomena are caused by the accumulation and degeneration of spermatozoa in the cauda epididymidis.

Development of chronic pain in males with traumatic spinal cord injury: role of circulating levels of the chemokines CCL2 and CXCL10 in subacute stage.

STUDY DESIGN: Longitudinal study. OBJECTIVES: To assess the impact of spinal cord injury (SCI) on circulating levels of chemokines (CCL2 and CXCL10) and its relation with pain development. SETTING: National Hospital for SCI patients. METHODS: We longitudinally studied changes in the circulating levels of CCL2 and CXCL10 in 27 male patients with complete SCI who were evaluated in the early subacute phase and indeed 3 and 6 months after injury measuring at each time-point serum levels of CCL2 and CXCL10. Patients were telephonically interviewed about pain 1 year after SCI. RESULTS: In the early subacute phase, patients with pain showed higher CXCL10 and similar CCL2 levels as opposed to those without pain. Moreover, CCL2 concentrations were positively associated with pain intensity. The results obtained by analysing the temporal profile of the chemokines suggested that CXCL10 was inclined to decrease over time, while CCL2 increased over time. CONCLUSION: The results of this preliminary study, the first performed in humans with traumatic SCI, suggest a link between changes in the circulating chemokine profile and pain development in subacute SCI stage as well as with severity in a more chronic stage. Large series studies will evaluate whether the circulating chemokine status can be useful as a biomarker for assessing the patients' risk for pain development.

[Sexual life quality of spinal cord-injured men receiving pharmacological treatment for erectile dysfunction and their partners]. / Calidad de la vida sexual de varones heterosexuales con lesión medular en tratamiento farmacológico para la disfunción eréctil y de sus compañeras.

OBJECTIVE: To assess the quality of sexual life reported by spinal cord-injured men treated with oral drugs for erectile dysfunction (ED) and their female partners. MATERIAL AND METHOD: Men with spinal cord injuries (SCI) complaining of ED and their female partners were evaluated using the Sexual Life Quality Questionnaire (SLQQ), a fully validated instrument in Spain. Two studies were conducted. A transversal study (1) on patients who were already on treatment with phosphodiesterase type 5 inhibitors (PDE5Is) and their partners, with 73 couples providing valid data. An additional prospective study (2) assessed SCI patients naive to PDE5Is in which both the patients and their spouses answered the SLQQ before treatment and after 3 months taking PDE5Is regularly, with 12 couples completing the study. RESULTS: The SLQQ scores of SC injured men on PDE5Is (study 1) were under the remembered pre-lesion level, with lower scores reported by those with complete lesions (P<.2 vs incomplete). Their partners' SLQQ scores were apparently similar to pre-injury times. The SLQQ scores of the patients and their partners were well correlated (r = 0.57, P<.0001), and they both reported high treatment satisfaction. Study 2: Untreated SCI patients reported very low SLQQ scores that were improved by PDE5Is treatment (P<.004), albeit without reaching the pre-injury level. A similar trend was found in their partners. Again both patients and partners reported high treatment satisfaction scores (P <.001). CONCLUSION: The sexual life quality levels of SC injured men on PDE5Is and their able-bodied spouses are well correlated. Both partners report high treatment satisfaction scores.

Calidad de la vida sexual de varones heterosexuales con lesión medular en tratamiento farmacológico para la disfunción eréctil y de sus compañeras / Sexual life quality of spinal cord-injured men receiving pharmacological treatment for erectile dysfunction and their partners

Objetivo: Evaluar la calidad de vida sexual de los varones con lesión medular (LM) con tratamiento farmacológico para la disfunción eréctil (DE) y de sus compañeras. Material y método: Se evaluó a varones de 18 a 65 años con LM y pareja estable que estuviesen en tratamiento de su DE mediante fármacos inhibidores de la fosfodiesterasa tipo 5 (iFDE5) o solicitasen iniciarlo. Se realizaron 2 estudios: un estudio transversal, sobre pacientes ya en tratamiento para la DE y sus compañeras, para el que 78 parejas proporcionaron datos válidos. Se complementó con un estudio prospectivo, sobre pacientes que iniciaban tratamiento para la DE y sus compañeras, comparando sus repuestas antes y a los 3 meses de iniciar el tratamiento; completaron este estudio 12 de las parejas invitadas. Los pacientes y sus parejas respondieron separadamente al Cuestionario de Calidad de Vida Sexual (SLQQ), validado en España. Resultados: Estudio transversal: las puntuaciones de la Escala de Calidad de Vida Sexual (parte I del cuestionario SLQQ) de los lesionados medulares en tratamiento fue inferior a la recordada con anterioridad a la lesión; por el contrario, para sus compañeras era similar a la prelesional. Las puntuaciones de ambos miembros de la pareja mostraron una robusta correlación (r = 0,57, p < 0,0001). Las puntuaciones de los pacientes con lesiones completas fueron inferiores a las lesiones incompletas (p < 0,02). Respecto a la satisfacción con el tratamiento (parte II del cuestionario SLQQ), las puntuaciones de los pacientes y sus compañeras estaban próximas al valor máximo de la escala y la prueba de Wilcoxon con respecto al valor de referencia fue muy significativa en ambos (p < 0,0001). Estudio prospectivo: los lesionados medulares mostraron bajas puntuaciones antes del tratamiento, que aumentaron significativamente a los 3 meses del tratamiento (p < 0,004). Las puntuaciones de satisfacción con el tratamiento fueron altas en ambos miembros de la pareja (p < 0,001). Conclusión: Los niveles de calidad de vida sexual informados por los pacientes con LM tratados con iFDE5 y sus compañeras sanas se muestran correlacionados. Ambos miembros de la pareja informaron de buena satisfacción con el tratamiento

Objective: To assess the quality of sexual life reported by spinal cord-injured men treated with oral drugs for erectile dysfunction (ED) and their female partners. Material and method: Men with spinal cord injuries (SCI) complaining of ED and their female partners were evaluated using the Sexual Life Quality Questionnaire (SLQQ), a fully validated instrument in Spain. Two studies were conducted. A transversal study (1) on patients who were already on treatment with phosphodiesterase type 5 inhibitors (PDE5Is) and their partners, with 73 couples providing valid data. An additional prospective study (2) assessed SCI patients naive to PDE5Is in which both the patients and their spouses answered the SLQQ before treatment and after 3 months taking PDE5Is regularly, with 12 couples completing the study. Results: The SLQQ scores of SC injured men on PDE5Is (study 1) were under the remembered pre-lesion level, with lower scores reported by those with complete lesions (P<.2 vs incomplete). Their partners' SLQQ scores were apparently similar to pre-injury times. The SLQQ scores of the patients and their partners were well correlated (r = 0.57, P<.0001), and they both reported high treatment satisfaction. Study 2: Untreated SCI patients reported very low SLQQ scores that were improved by PDE5Is treatment (P<.004), albeit without reaching the pre-injury level. A similar trend was found in their partners. Again both patients and partners reported high treatment satisfaction scores (P <.001). Conclusion: The sexual life quality levels of SC injured men on PDE5Is and their able-bodied spouses are well correlated. Both partners report high treatment satisfaction scores

The influence of chronic prostatitis in spinal cord injured patients and seminal plasma characteristics: doubts and proven truths

Introduction: Functional ejaculation depends on the preservation of thoracolumbar segments T11-L2, sacral segments S2-S4, and their afferences and efferences. In spinal cord injury (SCI), ejaculatory dysfunction is most likely the cause of deterioration in sperm quality. There are several factors that can change the quality of semen, seminal plasma being the major contributor to the alterations seen in this group of patients. Prostate and seminal vesicles are the main producers of seminal fluid, its secretory function being altered in SCI. Objectives: The literature was reviewed to determine the influence of chronic prostatitis in SCI in the characteristics of seminal plasma. Material and methods: A search was made in the PubMed literature using the MeSH terms "spinal cord injury," "prostatitis" and "semen analysis," looking for articles in English, Spanish and Portuguese, without publication date limits with the subsequent addition of "related citations". Results: Several studies have shown that men with chronic prostatitis have significant alterations of sperm quality. Leukocytospermia in SCI is not due to acute or chronic inflammation of the prostate gland. Discussion: The cause of abnormal sperm function in patients with SCI remains unclear, but it is thought to be multifactorial. More research is needed to establish the causal relationship between prostatitis and decreased sperm quality in patients with SCI (AU)

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Disfunción eréctil de origen neurológico / Neurogenic erectile dysfunction

La disfunción eréctil (DE) de causa neurológica, se produce como consecuencia de las alteraciones de las vías nerviosas tanto autonómicas como somáticas o la combinación de ambas y de los componentes cerebrales que inducen la erección. Esta revisión intenta explicar los mecanismos fisiopatológicos de las más frecuentes alteraciones neurológicas que causan disfunción eréctil y trastornos sexuales(AU)

Neurogenic erectile dysfunction is a consequence of alterations in neural pathways, autonomic, somatic, the combination of both or brain components that induce erection. This review aims to explain the physiopathological mechanisms of the most frequent neurological alterations causing erectile dysfunction and sexual disorders(AU)

Efficacy and safety of tadalafil in men with erectile dysfunction following spinal cord injury.

OBJECTIVE: To determine the efficacy and safety of tadalafil when taken on demand by men with erectile dysfunction (ED) secondary to traumatic spinal cord injury (SCI). DESIGN AND SETTING: Multicenter, randomized, double-blind, placebo-controlled, flexible dose-titration, parallel-group study in clinical practices in Europe. Patients Enrolled patients had ED secondary to SCI (all spinal levels) and sustained 6 months or longer before visit 1. INTERVENTIONS: After a 4-week run-in period, patients were randomly assigned to tadalafil, 10 mg, (n = 142) or placebo (n = 44) for a 12-week, on-demand treatment period with assessments at 4-week intervals. The dose of tadalafil was maintained or titrated (10 or 20 mg) at 4 and 8 weeks. MAIN OUTCOME MEASURES: Efficacy was measured using the International Index of Erectile Function (IIEF), Sexual Encounter Profile (SEP), and Global Assessment Question (GAQ). Treatment-emergent adverse events and vital signs were collected at each visit. RESULTS: Mean age was 38 years. Mean baseline IIEF erectile function domain score was 13.4, and following 12 weeks of treatment, 22.6 for tadalafil and 13.6 for placebo (P < .001). After treatment, the tadalafil group compared with the placebo group was significantly greater (P < .001) in mean per-patient percentage of successful penetration attempts (SEP question 2; 75.4% vs 41.1%) and intercourse attempts (SEP question 3; 47.6% vs 16.8%); percentage of improved erections (GAQ question 1; 84.6% vs 19.5%); and ejaculatory frequency (IIEF question 9; P = .03). The 2 most common treatment-emergent adverse events in the tadalafil group compared with placebo were headache (8.5% vs 4.5%) and urinary tract infection (7.7% vs 6.8%). CONCLUSIONS: Tadalafil (10 mg and 20 mg) improved erectile function and was well tolerated by men with ED secondary to traumatic SCI.