Roth J D, Misseri R, Cain M P, Szymanski K M
Division of Pediatric Urology, Riley Hospital for Children at IU Health, 705 Riley Hospital Dr., Suite 4230, Indianapolis, IN 46202, USA.
Division of Pediatric Urology, Riley Hospital for Children at IU Health, 705 Riley Hospital Dr., Suite 4230, Indianapolis, IN 46202, USA.
J Pediatr Urol. 2017 Jun;13(3):264.e1-264.e6. doi: 10.1016/j.jpurol.2016.12.004. Epub 2017 Jan 11.
Little is known about erectile dysfunction (ED) among men with spina bifida (SB). The goal of this study was to determine quality of erections and possible factors affecting erections in this population. It was hypothesized that men who ambulate and do not have a ventriculoperitoneal shunt (VPS) are more likely to have erections sufficient for intercourse.
An online survey was administered over an 18-month period to men aged ≥18 years and with SB. Participants were recruited through local, national and international SB organizations via social media. Exclusion criteria were: poor English proficiency, not completing the questionnaire or missing information regarding erections, VPS or ambulation. Data were collected on demographics, previous surgeries and function. Ambulatory status was classified using the Hoffer classification (Hoffer et al., 1973). Those able to walk at least at home, with or without crutches/braces, were classified as "ambulators." Erections were assessed using a single question from the validated Expanded Prostate Cancer Index Composite questionnaire (e.g. normal: "firm enough for intercourse"). Logistic regression was used for statistical analysis.
The median age of 122 participants was 33 years, 53.3% were ambulators and 70.5% had a VPS. Overall, 41.0% reported normal erections. Ambulators were more likely to report normal erections than non-ambulators (63.1% vs 15.8%, P < 0.001) (Table). Those with and without a VPS reported similar rates of normal erections (37.9% vs 48.6%, P = 0.32). On multivariate analysis, ambulators were more likely to have normal erections (OR ≥8.65, P ≤ 0.001) after correcting for age and VPS status. Age and VPS status were not correlated with normal erections on multivariate analysis (P ≥ 0.32 and P = 0.62, respectively).
Approximately 59% of men with SB reported ED, with ambulators being far more likely to have normal erections. This suggests that ambulatory status, similar to neurological lesion level, is a confounder of erectile function in the SB population. A limitation of the study was that a single item was used to assess erectile function. Rather than performing a comprehensive analysis of sexual health, the study aimed to gauge the prevalence of normal erections and assess possible risk factors. It did not assess sexual activity, erection duration or ED treatments. However, this is the largest study, to date, on SB and erectile quality with international participants.
About 40% of men with SB reported normal erections. Ambulatory status, rather than hydrocephalus, appeared to be the primary factor associated with erectile function. Approximately 2/3 of ambulators and 1/6 of non-ambulators reported normal erections.
关于脊柱裂（SB）男性患者的勃起功能障碍（ED），我们所知甚少。本研究的目的是确定该人群的勃起质量以及影响勃起的可能因素。我们假设能够行走且没有脑室腹腔分流术（VPS）的男性更有可能勃起充分以进行性交。
在18个月的时间里，对年龄≥18岁的SB男性进行了一项在线调查。通过当地、国家和国际SB组织通过社交媒体招募参与者。排除标准为：英语水平差、未完成问卷或缺少有关勃起、VPS或行走能力的信息。收集了有关人口统计学、既往手术和功能的数据。使用霍弗分类法（Hoffer等人，1973年）对行走能力进行分类。那些至少能够在家中行走，无论是否使用拐杖/支具的人被归类为“行走者”。使用经过验证的扩展前列腺癌指数综合问卷中的一个问题来评估勃起情况（例如正常：“坚硬到足以进行性交”）。使用逻辑回归进行统计分析。
122名参与者的中位年龄为33岁，53.3%为行走者，70.5%有VPS。总体而言,41.0%的人报告勃起正常。行走者比非行走者更有可能报告勃起正常（63.1%对15.8%，P<0.001）（表）。有和没有VPS的人报告勃起正常的比例相似（37.9%对48.6%，P=0.32）。在多变量分析中，校正年龄和VPS状态后，行走者更有可能勃起正常（OR≥8.65，P≤0.001）。在多变量分析中，年龄和VPS状态与勃起正常无关（分别为P≥0.32和P=0.62）。
大约59%的SB男性报告有ED，行走者勃起正常的可能性要大得多。这表明行走状态与神经病变水平一样，是SB人群勃起功能的一个混杂因素。该研究的一个局限性是使用了单个项目来评估勃起功能。该研究旨在衡量正常勃起的患病率并评估可能的风险因素，而不是对性健康进行全面分析。它没有评估性活动、勃起持续时间或ED治疗。然而，这是迄今为止关于SB和勃起质量的最大规模的国际参与者研究。
约40%的SB男性报告勃起正常。行走状态而非脑积水似乎是与勃起功能相关的主要因素。大约2/3的行走者和1/6的非行走者报告勃起正常。
