Sinha Varsha, Elliott Stacy, Ibrahim Emad, Lynne Charles M, Brackett Nancy L
Department of Urology, University of Miami Miller School of Medicine, Miami, Florida.
Departments of Psychiatry and Urologic Sciences, International Collaboration On Repair Discoveries (ICORD), Vancouver, BC, Canada.
Top Spinal Cord Inj Rehabil. 2017 Winter;23(1):31-41. doi: 10.1310/sci2301-31.
Most men with spinal cord injury (SCI) are infertile due to a combination of erectile dysfunction, ejaculatory dysfunction, and abnormal semen quality. This article addresses issues that should be considered when managing the reproductive health of men with SCI. The authors present recommendations based on their decades of experience in managing the reproductive health of more than 1,000 men with SCI. Men with SCI face obstacles when pursuing sexual activity and/or biologic fatherhood. Hypogonadism and premature symptoms of aging may interfere with sexual function. Erectile dysfunction is prevalent in the SCI population, and treatments for erectile dysfunction in the general population are also effective in the SCI population. Most men with SCI cannot ejaculate with sexual intercourse. The procedures of penile vibratory stimulation (PVS) and/or electroejaculation (EEJ) are effective in obtaining an ejaculate from 97% of men with SCI. The ejaculate often contains sufficient total motile sperm to consider the assisted conception procedures of intrauterine insemination or even intravaginal insemination at home. If PVS and/or EEJ fail, sperm may be retrieved surgically from the testis or epididymis. Surgical sperm retrieval typically yields enough motile sperm only for in vitro fertilization with intracytoplasmic sperm injection. The majority of new cases of SCI occur in young men at the peak of their reproductive health. With proper medical management, these men can expect to experience active sexual lives and biologic fatherhood, if these are their goals. Numerous tools are available to physicians for helping these patients reach their goals.
大多数脊髓损伤（SCI）男性由于勃起功能障碍、射精功能障碍和精液质量异常等多种因素而不育。本文探讨了在管理脊髓损伤男性生殖健康时应考虑的问题。作者根据他们在管理1000多名脊髓损伤男性生殖健康方面数十年的经验提出了建议。脊髓损伤男性在进行性活动和/或成为生物学父亲方面面临障碍。性腺功能减退和过早的衰老症状可能会干扰性功能。勃起功能障碍在脊髓损伤人群中很普遍，普通人群中治疗勃起功能障碍的方法在脊髓损伤人群中也有效。大多数脊髓损伤男性无法通过性交射精。阴茎振动刺激（PVS）和/或电射精（EEJ）程序能有效使97%的脊髓损伤男性射精。射出的精液通常含有足够数量的活动精子，可考虑进行宫内授精甚至在家中进行阴道内授精等辅助受孕程序。如果PVS和/或EEJ失败，可以通过手术从睾丸或附睾中获取精子。手术取精通常只能获得足够数量的活动精子用于卵胞浆内单精子注射体外受精。大多数新的脊髓损伤病例发生在生殖健康高峰期的年轻男性身上。通过适当的医疗管理，如果这些是他们的目标，这些男性有望过上积极的性生活并成为生物学父亲。医生有许多工具可帮助这些患者实现目标。
