Department of Urology, University of Miami, Miller School of Medicine, Miami, Florida; The Miami Project to Cure Paralysis, University of Miami, Miller School of Medicine, Miami, Florida.
Department of Urology, University of Miami, Miller School of Medicine, Miami, Florida.
Fertil Steril. 2021 May;115(5):1344-1346. doi: 10.1016/j.fertnstert.2021.01.012. Epub 2021 Mar 10.
To demonstrate the proper technique to perform electroejacuation (EEJ) in men with spinal cord injury (SCI) for the purpose of inducing ejaculation.
A video demonstration of the proper technique to perform EEJ in men with SCI using the Seager model 14 electroejaculation machine.
Major university medical center.
PATIENT(S): Men with SCI; institutional review board approval was obtained, and all subjects signed an informed consent form.
INTERVENTION(S): Spinal cord injury occurs mostly in young men where the majority suffer from ejaculatory dysfunction. The method of choice to induce ejaculation in penile vibratory stimulation (PVS). PVS is successful in 86% of men with SCI whose level of injury is T10 or rostral. If PVS fails or the level is Caudal to T10, the patient is referred for EEJ. This video will demonstrate the proper technique for successful ejaculation using EEJ. Patients with history of autonomic dysreflexia or their level of injury is T6 or rostral are pretreated with 10-20 mg of nifedipine sublingually 10 minutes before stimulation. The patient is then placed in the lateral decubitus position. The bladder is emptied, and a buffer is instilled. An anoscopy is performed, and a rectal probe is placed. A current is delivered until an antegrade ejaculation is retrieved. A retrograde specimen is collected and examined for sperm identification. Patients with complete SCI (no sensory or motor function is preserved in sacral segments S4-S5) can undergo EEJ without anesthesia. Patients with incomplete SCI (significant nerve sparing or normal sensations) will experience pain during stimulation, and general anesthesia is recommended without the use of muscle relaxing agents.
MAIN OUTCOME MEASURE(S): Successful ejaculation after performing EEJ in men with SCI.
RESULT(S): Electroejacuation is successful in 95% of men with SCI and in nearly 100% if general anesthesia is used. Outcomes of in vitro fertilization or intracytoplasmic sperm injection after EEJ showed 37.5% pregnancy rate per cycle, 50.0% pregnancy rate per couple, 33.3% live birth rate per cycle, and 43.8% live birth rate per couple. No complications due to EEJ were observed in 953 trials, and none occurred in the patients presented in this video demonstration.
CONCLUSION(S): Electroejacuation is a safe and reliable method for induction of ejaculation in men with SCI who fail a trial of PVS.
展示对脊髓损伤（SCI）男性进行电刺激射精（EEJ）的正确技术，以诱导射精。
使用 Seager 模型 14 电刺激射精机对 SCI 男性进行 EEJ 的正确技术的视频演示。
主要大学医疗中心。
SCI 男性；获得机构审查委员会批准，所有受试者均签署知情同意书。
SCI 主要发生在年轻男性中，其中大多数患有射精功能障碍。阴茎振动刺激（PVS）是诱导射精的首选方法。在损伤水平为 T10 或高位的 86%的 SCI 男性中，PVS 是成功的。如果 PVS 失败或损伤水平在 T10 以下，则将患者转介进行 EEJ。该视频将演示使用 EEJ 成功射精的正确技术。有自主反射障碍病史或损伤水平为 T6 或高位的患者，在刺激前 10 分钟舌下含服 10-20 毫克硝苯地平进行预处理。然后将患者置于侧卧位。排空膀胱，并注入缓冲液。进行肛门镜检查，并放置直肠探头。施加电流，直到取回顺行射精。收集逆行标本并检查精子鉴定。完全性 SCI（骶段 S4-S5 无感觉或运动功能保留）的患者可在无麻醉的情况下进行 EEJ。不完全性 SCI（有显著神经保留或正常感觉）的患者在刺激过程中会感到疼痛，建议使用全身麻醉，而不使用肌肉松弛剂。
SCI 男性进行 EEJ 后的成功射精。
95%的 SCI 男性 EEJ 成功，如使用全身麻醉则成功率接近 100%。EEJ 后的体外受精或胞浆内精子注射结果显示，每个周期的妊娠率为 37.5%，每对夫妇的妊娠率为 50.0%，每个周期的活产率为 33.3%，每对夫妇的活产率为 43.8%。953 次试验中未观察到 EEJ 引起的并发症，本视频演示中的患者也未发生。
EEJ 是 PVS 试验失败的 SCI 男性诱导射精的安全可靠方法。
