The influence of bladder management on fertility in spinal cord injured males.

Male infertility is a well recognised problem following spinal cord injury. The techniques of vibration induced ejaculation and transrectal electroejaculation have significantly increased the likelihood of sperm retrieval in spinal cord injured males; however, the reproductive capacity remains markedly reduced due to poor semen quality. The Spinal Injuries Unit at Royal North Shore Hospital has developed a programme to achieve seminal emission and enhance fertility. This study analysed the results of the first sample obtained at stimulation in 70 spinal cord injured males with respect to procedure performed, neurological level, completeness of lesion, bladder management, infection, age and duration since injury. Our study demonstrated that bladder management and neurological level were significant factors affecting the presence of motile sperm. Individuals managing their neuropathic bladder by catheter (intermittent self-catheterisation, indwelling urethral or suprapubic catheter) had significantly enhanced semen quality compared to those voiding by reflex or straining. Differences were also noted within the catheter group itself with intermittent self-catheterisation achieving a higher percentage of motile sperm present.