Anesthetic block of the dorsal penile nerve inhibits vibratory-Induced ejaculation in men with spinal cord injuries

Jeff A. Wieder, Nancy Brackett, Charles M Lynne, Joshua T. Green, Teodoro C. Aballa

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

Objectives. We investigated which nerve pathways are necessary to achieve ejaculation using penile vibratory stimulation (PVS) in men with spinal cord injury (SCI). Methods. Eight men with SCI were selected based on the presence of a bulbocavernosus reflex (BCR) and consistent antegrade ejaculation with PVS. Level of injury was cervical (4), upper thoracic (4), and lower thoracic (1). Mean age was 30.4 years (range 22 to 38). Usual responses to PVS included autonomic dysreflexia (4), erection (4), and consistent somatic responses such as abdominal contractions (8). Local anesthesia of the dorsal penile nerves (penile block) was achieved using 1% plain lidocaine injection. Effective penile block was confirmed by loss of the BCR. Two PVS ejaculation trials were performed: one trial during the penile block and one trial when the penile block had worn off. In 4 subjects, the bladder contents were analyzed for retrograde ejaculation. Results. With the penile block, ejaculation was inhibited in 100% of the subjects. None of the bladder washings demonstrated sperm, indicating absence of retrograde ejaculation. None of the subjects exhibited their usual erectile response, somatic responses, or signs of autonomic dysreflexia. After the penile block wore off, PVS induced ejaculation in all subjects. If subjects usually had erection, somatic responses, or signs of autonomic dysreflexia, these also returned. Conclusions. Our data suggest that ejaculatory response to PVS in SCI men requires the presence of intact dorsal penile nerves. Copyright (C) 2000 Elsevier Science Inc.

Original languageEnglish
Pages (from-to)915-917
Number of pages3
JournalUrology
Volume55
Issue number6
DOIs
StatePublished - Jun 1 2000

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Pudendal Nerve
Ejaculation
Spinal Cord Injuries
Anesthetics
Autonomic Dysreflexia
Reflex
Urinary Bladder
Thorax
Spinal Cord Stimulation
Nerve Block
Local Anesthesia
Lidocaine
Spermatozoa
Injections
Wounds and Injuries

ASJC Scopus subject areas

  • Urology

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Anesthetic block of the dorsal penile nerve inhibits vibratory-Induced ejaculation in men with spinal cord injuries. / Wieder, Jeff A.; Brackett, Nancy; Lynne, Charles M; Green, Joshua T.; Aballa, Teodoro C.

In: Urology, Vol. 55, No. 6, 01.06.2000, p. 915-917.

Research output: Contribution to journalArticle

Wieder, Jeff A. ; Brackett, Nancy ; Lynne, Charles M ; Green, Joshua T. ; Aballa, Teodoro C. / Anesthetic block of the dorsal penile nerve inhibits vibratory-Induced ejaculation in men with spinal cord injuries. In: Urology. 2000 ; Vol. 55, No. 6. pp. 915-917.
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abstract = "Objectives. We investigated which nerve pathways are necessary to achieve ejaculation using penile vibratory stimulation (PVS) in men with spinal cord injury (SCI). Methods. Eight men with SCI were selected based on the presence of a bulbocavernosus reflex (BCR) and consistent antegrade ejaculation with PVS. Level of injury was cervical (4), upper thoracic (4), and lower thoracic (1). Mean age was 30.4 years (range 22 to 38). Usual responses to PVS included autonomic dysreflexia (4), erection (4), and consistent somatic responses such as abdominal contractions (8). Local anesthesia of the dorsal penile nerves (penile block) was achieved using 1{\%} plain lidocaine injection. Effective penile block was confirmed by loss of the BCR. Two PVS ejaculation trials were performed: one trial during the penile block and one trial when the penile block had worn off. In 4 subjects, the bladder contents were analyzed for retrograde ejaculation. Results. With the penile block, ejaculation was inhibited in 100{\%} of the subjects. None of the bladder washings demonstrated sperm, indicating absence of retrograde ejaculation. None of the subjects exhibited their usual erectile response, somatic responses, or signs of autonomic dysreflexia. After the penile block wore off, PVS induced ejaculation in all subjects. If subjects usually had erection, somatic responses, or signs of autonomic dysreflexia, these also returned. Conclusions. Our data suggest that ejaculatory response to PVS in SCI men requires the presence of intact dorsal penile nerves. Copyright (C) 2000 Elsevier Science Inc.",
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AB - Objectives. We investigated which nerve pathways are necessary to achieve ejaculation using penile vibratory stimulation (PVS) in men with spinal cord injury (SCI). Methods. Eight men with SCI were selected based on the presence of a bulbocavernosus reflex (BCR) and consistent antegrade ejaculation with PVS. Level of injury was cervical (4), upper thoracic (4), and lower thoracic (1). Mean age was 30.4 years (range 22 to 38). Usual responses to PVS included autonomic dysreflexia (4), erection (4), and consistent somatic responses such as abdominal contractions (8). Local anesthesia of the dorsal penile nerves (penile block) was achieved using 1% plain lidocaine injection. Effective penile block was confirmed by loss of the BCR. Two PVS ejaculation trials were performed: one trial during the penile block and one trial when the penile block had worn off. In 4 subjects, the bladder contents were analyzed for retrograde ejaculation. Results. With the penile block, ejaculation was inhibited in 100% of the subjects. None of the bladder washings demonstrated sperm, indicating absence of retrograde ejaculation. None of the subjects exhibited their usual erectile response, somatic responses, or signs of autonomic dysreflexia. After the penile block wore off, PVS induced ejaculation in all subjects. If subjects usually had erection, somatic responses, or signs of autonomic dysreflexia, these also returned. Conclusions. Our data suggest that ejaculatory response to PVS in SCI men requires the presence of intact dorsal penile nerves. Copyright (C) 2000 Elsevier Science Inc.

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