Kasum Miro, Orešković Slavko, Kordić Mario, Čehić Ermin, Hauptman Dinko, Ejubović Emina, Lila Albert, Smolčić Gordana
University Department of Obstetrics and Gynecology, Zagreb University Hospital Centre, School of Medicine, University of Zagreb, Zagreb, Croatia.
School of Medicine, University of Zagreb, Zagreb, Croatia.
Acta Clin Croat. 2018 Mar;57(1):149-156. doi: 10.20471/acc.2018.57.01.19.
The aim of the review is to establish sexual and reproductive functions in men with spinal cord lesion (SCL). Many sexual and reproductive dysfunctions may be found in these patients including individual's low self-esteem, delay of orgasm, erectile or ejaculatory disorder and abnormalities of semen, which are characterized by lower sperm motility or viability. Owing to improvements in physical medicine and rehabilitation, the focus has been shifted from keeping patients alive towards ensuring the quality of life and improvements of sexual dysfunctions and later reproduction. Erectile dysfunction can be treated by using phosphodiesterase-5 inhibitors, intracavernosal injections, vacuum devices and penile prostheses. Semen can be retrieved from anejaculatory patients by medically assisted methods utilizing penile vibratory stimulation, electroejaculation, prostate mas-sage, or surgically. Although there is low chance for pregnancy in natural way in most of SCL pa-tients, fatherhood is possible through the introduction of assisted medical management. By use of various medical, technical and surgical procedures for sperm retrieval combined with assisted reproductive methods, high pregnancy rates have been reported comparable to those in able-bodied subfertile patients. Nevertheless, future studies are needed to improve semen quality and methods of assisted ejaculation in patients with SCL.
本综述的目的是确定脊髓损伤(SCL)男性的性和生殖功能。这些患者可能存在许多性和生殖功能障碍,包括个人自尊心低落、性高潮延迟、勃起或射精障碍以及精液异常,其特征为精子活力或存活率较低。由于物理医学与康复的进步,重点已从维持患者生命转向确保生活质量以及改善性功能障碍和后期生殖功能。勃起功能障碍可通过使用磷酸二酯酶-5抑制剂、海绵体内注射、真空装置和阴茎假体进行治疗。对于不射精患者,可通过阴茎振动刺激、电射精、前列腺按摩等医学辅助方法或手术方法获取精液。尽管大多数SCL患者自然受孕的几率较低,但通过引入辅助医疗管理,成为父亲是有可能的。通过使用各种用于获取精子的医学、技术和外科程序,并结合辅助生殖方法,已报告有与健全的不育患者相当的高妊娠率。然而,未来仍需要开展研究以改善SCL患者的精液质量和辅助射精方法。