Blood pressure changes during sexual stimulation, ejaculation and midodrine treatment in men with spinal cord injury
Associate Editor Michael G. Wyllie Editorial Board Ian Eardley, UK Jean Fourcroy, USA Sidney Glina, Brazil Julia Heiman, USA Chris McMahon, Australia Bob Millar, UK Alvaro Morales, Canada Michael Perelman, USA Marcel Waldinger, Netherlands OBJECTIVES To explore the effectiveness of various sources o...
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| creator | Courtois, Frédérique J. Charvier, Kathleen F. Leriche, Albert Vézina, Jean‐Guy Côté, Magalie Bélanger, Marc |
| description | Associate Editor
Michael G. Wyllie
Editorial Board
Ian Eardley, UK
Jean Fourcroy, USA
Sidney Glina, Brazil
Julia Heiman, USA
Chris McMahon, Australia
Bob Millar, UK
Alvaro Morales, Canada
Michael Perelman, USA
Marcel Waldinger, Netherlands
OBJECTIVES
To explore the effectiveness of various sources of self‐stimulation, including oral midodrine, in triggering ejaculation in men with spinal cord injury (SCI), and to document the systematic variations in blood pressure at ejaculation and consider a revised definition of autonomic dysreflexia.
PATIENTS AND METHODS
The study included 62 men with SCI lesions from C2 to L2. Ejaculation potential was assessed with various sources of stimulation, beginning with natural stimulation, followed, if the test was negative, by penile vibrator stimulation (PVS) followed, if the test was again negative, by PVS combined with oral midodrine, started at 5 mg and increased in 5 mg steps up to 25 mg. The success rate of ejaculation was recorded, as were blood pressure (BP) changes measured at baseline and at ejaculation (or on the last trial if the test was negative). Reported sensations were also recorded and compared during positive and negative tests.
RESULTS
Overall, 89% of the patients reached ejaculation with one mode or another of stimulation. When patients had a negative result with natural stimulation, 56% were salvaged by PVS, and when PVS was negative, another 22% were salvaged by midodrine combined with PVS. The mean systolic BP increased by 35 mmHg at ejaculation during PVS and by 11 mmHg after midodrine, and a subsequent 29 mmHg at ejaculation during PVS combined with midodrine. By contrast, negative tests showed a relatively stable BP; the difference in changes in BP during positive and negative tests was significant (P |
| doi_str_mv | 10.1111/j.1464-410X.2007.07254.x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_70201592</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>70201592</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4524-b94a578acfee1504df0fb2189eae64a55363a3b4afc6fc5daebd4baad2d83d0a3</originalsourceid><addsrcrecordid>eNqNkEtP3DAQgK2qVaGUv4B8oSc2tR07j0MPBUEfQuqlSNysiT0BR4mz2InY_fd1uilc68uMZ74ZWx8hlLOMp_O5y7gs5EZydp8JxsqMlULJbPeGHL803v7LWV0ckQ8xdoylQqHekyNe1kJUqjgm02U_jpZuA8Y4B6TmEfwDRmrn4PwDjbiboadxcsPcw-RGf0GxA7NeKHhLB2dHm2ikU0CYBvQTdZ6mSJ_d9Ejj1vm0w4zBpno3h_1H8q6FPuLpGk_I3c3176vvm9tf335cfb3dGKmE3DS1BFVWYFpErpi0LWsbwasaAYvUUnmRQ95IaE3RGmUBGysbACtslVsG-Qn5dNi7DePTjHHSg4sG-x48jnPUJROMq1oksDqAJowxBmz1NrgBwl5zphfjutOLTL2I1Ytx_de43qXRs_WNuRnQvg6uihNwvgIQDfRtAG9cfOXquq7S7sR9OXDPrsf9f39AX_68W7L8D0cgoIg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>70201592</pqid></control><display><type>article</type><title>Blood pressure changes during sexual stimulation, ejaculation and midodrine treatment in men with spinal cord injury</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Courtois, Frédérique J. ; Charvier, Kathleen F. ; Leriche, Albert ; Vézina, Jean‐Guy ; Côté, Magalie ; Bélanger, Marc</creator><creatorcontrib>Courtois, Frédérique J. ; Charvier, Kathleen F. ; Leriche, Albert ; Vézina, Jean‐Guy ; Côté, Magalie ; Bélanger, Marc</creatorcontrib><description>Associate Editor
Michael G. Wyllie
Editorial Board
Ian Eardley, UK
Jean Fourcroy, USA
Sidney Glina, Brazil
Julia Heiman, USA
Chris McMahon, Australia
Bob Millar, UK
Alvaro Morales, Canada
Michael Perelman, USA
Marcel Waldinger, Netherlands
OBJECTIVES
To explore the effectiveness of various sources of self‐stimulation, including oral midodrine, in triggering ejaculation in men with spinal cord injury (SCI), and to document the systematic variations in blood pressure at ejaculation and consider a revised definition of autonomic dysreflexia.
PATIENTS AND METHODS
The study included 62 men with SCI lesions from C2 to L2. Ejaculation potential was assessed with various sources of stimulation, beginning with natural stimulation, followed, if the test was negative, by penile vibrator stimulation (PVS) followed, if the test was again negative, by PVS combined with oral midodrine, started at 5 mg and increased in 5 mg steps up to 25 mg. The success rate of ejaculation was recorded, as were blood pressure (BP) changes measured at baseline and at ejaculation (or on the last trial if the test was negative). Reported sensations were also recorded and compared during positive and negative tests.
RESULTS
Overall, 89% of the patients reached ejaculation with one mode or another of stimulation. When patients had a negative result with natural stimulation, 56% were salvaged by PVS, and when PVS was negative, another 22% were salvaged by midodrine combined with PVS. The mean systolic BP increased by 35 mmHg at ejaculation during PVS and by 11 mmHg after midodrine, and a subsequent 29 mmHg at ejaculation during PVS combined with midodrine. By contrast, negative tests showed a relatively stable BP; the difference in changes in BP during positive and negative tests was significant (P < 0.01). Increases in BP during positive tests declined significantly more often within the limits of autonomic dysreflexia than negative tests (P < 0.01).
CONCLUSION
These results support the view that most men with SCI can obtain an ejaculation when a wide spectrum of stimulation is used, including natural stimulation, PVS, and PVS combined with oral midodrine. Positive tests were associated with significant increases in BP, in contrast to negative tests, where BP was relatively stable. This suggests that significant changes in BP are required for ejaculation and that insignificant changes are predictive of future failure. As most changes in BP during positive tests also fall within the criterion of autonomic dysreflexia, a revised definition of autonomic dysreflexia should be considered to encourage safe experiences with ejaculation and safe use of midodrine.</description><identifier>ISSN: 1464-4096</identifier><identifier>EISSN: 1464-410X</identifier><identifier>DOI: 10.1111/j.1464-410X.2007.07254.x</identifier><identifier>PMID: 17922856</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Adolescent ; Adrenergic alpha-Agonists - therapeutic use ; Adult ; Aged ; autonomic dysreflexia ; Autonomic Dysreflexia - etiology ; Autonomic Dysreflexia - prevention & control ; Biological and medical sciences ; Blood Pressure - drug effects ; Blood Pressure - physiology ; Cerebrospinal fluid. Meninges. Spinal cord ; ejaculation ; Ejaculation - drug effects ; Ejaculation - physiology ; Humans ; Male ; Medical sciences ; Middle Aged ; midodrine ; Midodrine - therapeutic use ; Nephrology. Urinary tract diseases ; Nervous system (semeiology, syndromes) ; Neurology ; penile vibratory stimulation ; Physical Stimulation - methods ; Predictive Value of Tests ; Retrospective Studies ; Sexual Dysfunction, Physiological - etiology ; Sexual Dysfunction, Physiological - therapy ; Spinal Cord Injuries - complications ; spinal cord injury ; Treatment Outcome ; Vibration - therapeutic use</subject><ispartof>BJU international, 2008-02, Vol.101 (3), p.331-337</ispartof><rights>2008 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4524-b94a578acfee1504df0fb2189eae64a55363a3b4afc6fc5daebd4baad2d83d0a3</citedby><cites>FETCH-LOGICAL-c4524-b94a578acfee1504df0fb2189eae64a55363a3b4afc6fc5daebd4baad2d83d0a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1464-410X.2007.07254.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1464-410X.2007.07254.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,778,782,1414,27911,27912,45561,45562</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=19998146$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17922856$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Courtois, Frédérique J.</creatorcontrib><creatorcontrib>Charvier, Kathleen F.</creatorcontrib><creatorcontrib>Leriche, Albert</creatorcontrib><creatorcontrib>Vézina, Jean‐Guy</creatorcontrib><creatorcontrib>Côté, Magalie</creatorcontrib><creatorcontrib>Bélanger, Marc</creatorcontrib><title>Blood pressure changes during sexual stimulation, ejaculation and midodrine treatment in men with spinal cord injury</title><title>BJU international</title><addtitle>BJU Int</addtitle><description>Associate Editor
Michael G. Wyllie
Editorial Board
Ian Eardley, UK
Jean Fourcroy, USA
Sidney Glina, Brazil
Julia Heiman, USA
Chris McMahon, Australia
Bob Millar, UK
Alvaro Morales, Canada
Michael Perelman, USA
Marcel Waldinger, Netherlands
OBJECTIVES
To explore the effectiveness of various sources of self‐stimulation, including oral midodrine, in triggering ejaculation in men with spinal cord injury (SCI), and to document the systematic variations in blood pressure at ejaculation and consider a revised definition of autonomic dysreflexia.
PATIENTS AND METHODS
The study included 62 men with SCI lesions from C2 to L2. Ejaculation potential was assessed with various sources of stimulation, beginning with natural stimulation, followed, if the test was negative, by penile vibrator stimulation (PVS) followed, if the test was again negative, by PVS combined with oral midodrine, started at 5 mg and increased in 5 mg steps up to 25 mg. The success rate of ejaculation was recorded, as were blood pressure (BP) changes measured at baseline and at ejaculation (or on the last trial if the test was negative). Reported sensations were also recorded and compared during positive and negative tests.
RESULTS
Overall, 89% of the patients reached ejaculation with one mode or another of stimulation. When patients had a negative result with natural stimulation, 56% were salvaged by PVS, and when PVS was negative, another 22% were salvaged by midodrine combined with PVS. The mean systolic BP increased by 35 mmHg at ejaculation during PVS and by 11 mmHg after midodrine, and a subsequent 29 mmHg at ejaculation during PVS combined with midodrine. By contrast, negative tests showed a relatively stable BP; the difference in changes in BP during positive and negative tests was significant (P < 0.01). Increases in BP during positive tests declined significantly more often within the limits of autonomic dysreflexia than negative tests (P < 0.01).
CONCLUSION
These results support the view that most men with SCI can obtain an ejaculation when a wide spectrum of stimulation is used, including natural stimulation, PVS, and PVS combined with oral midodrine. Positive tests were associated with significant increases in BP, in contrast to negative tests, where BP was relatively stable. This suggests that significant changes in BP are required for ejaculation and that insignificant changes are predictive of future failure. As most changes in BP during positive tests also fall within the criterion of autonomic dysreflexia, a revised definition of autonomic dysreflexia should be considered to encourage safe experiences with ejaculation and safe use of midodrine.</description><subject>Adolescent</subject><subject>Adrenergic alpha-Agonists - therapeutic use</subject><subject>Adult</subject><subject>Aged</subject><subject>autonomic dysreflexia</subject><subject>Autonomic Dysreflexia - etiology</subject><subject>Autonomic Dysreflexia - prevention & control</subject><subject>Biological and medical sciences</subject><subject>Blood Pressure - drug effects</subject><subject>Blood Pressure - physiology</subject><subject>Cerebrospinal fluid. Meninges. Spinal cord</subject><subject>ejaculation</subject><subject>Ejaculation - drug effects</subject><subject>Ejaculation - physiology</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>midodrine</subject><subject>Midodrine - therapeutic use</subject><subject>Nephrology. Urinary tract diseases</subject><subject>Nervous system (semeiology, syndromes)</subject><subject>Neurology</subject><subject>penile vibratory stimulation</subject><subject>Physical Stimulation - methods</subject><subject>Predictive Value of Tests</subject><subject>Retrospective Studies</subject><subject>Sexual Dysfunction, Physiological - etiology</subject><subject>Sexual Dysfunction, Physiological - therapy</subject><subject>Spinal Cord Injuries - complications</subject><subject>spinal cord injury</subject><subject>Treatment Outcome</subject><subject>Vibration - therapeutic use</subject><issn>1464-4096</issn><issn>1464-410X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkEtP3DAQgK2qVaGUv4B8oSc2tR07j0MPBUEfQuqlSNysiT0BR4mz2InY_fd1uilc68uMZ74ZWx8hlLOMp_O5y7gs5EZydp8JxsqMlULJbPeGHL803v7LWV0ckQ8xdoylQqHekyNe1kJUqjgm02U_jpZuA8Y4B6TmEfwDRmrn4PwDjbiboadxcsPcw-RGf0GxA7NeKHhLB2dHm2ikU0CYBvQTdZ6mSJ_d9Ejj1vm0w4zBpno3h_1H8q6FPuLpGk_I3c3176vvm9tf335cfb3dGKmE3DS1BFVWYFpErpi0LWsbwasaAYvUUnmRQ95IaE3RGmUBGysbACtslVsG-Qn5dNi7DePTjHHSg4sG-x48jnPUJROMq1oksDqAJowxBmz1NrgBwl5zphfjutOLTL2I1Ytx_de43qXRs_WNuRnQvg6uihNwvgIQDfRtAG9cfOXquq7S7sR9OXDPrsf9f39AX_68W7L8D0cgoIg</recordid><startdate>200802</startdate><enddate>200802</enddate><creator>Courtois, Frédérique J.</creator><creator>Charvier, Kathleen F.</creator><creator>Leriche, Albert</creator><creator>Vézina, Jean‐Guy</creator><creator>Côté, Magalie</creator><creator>Bélanger, Marc</creator><general>Blackwell Publishing Ltd</general><general>Blackwell</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200802</creationdate><title>Blood pressure changes during sexual stimulation, ejaculation and midodrine treatment in men with spinal cord injury</title><author>Courtois, Frédérique J. ; Charvier, Kathleen F. ; Leriche, Albert ; Vézina, Jean‐Guy ; Côté, Magalie ; Bélanger, Marc</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4524-b94a578acfee1504df0fb2189eae64a55363a3b4afc6fc5daebd4baad2d83d0a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adolescent</topic><topic>Adrenergic alpha-Agonists - therapeutic use</topic><topic>Adult</topic><topic>Aged</topic><topic>autonomic dysreflexia</topic><topic>Autonomic Dysreflexia - etiology</topic><topic>Autonomic Dysreflexia - prevention & control</topic><topic>Biological and medical sciences</topic><topic>Blood Pressure - drug effects</topic><topic>Blood Pressure - physiology</topic><topic>Cerebrospinal fluid. Meninges. Spinal cord</topic><topic>ejaculation</topic><topic>Ejaculation - drug effects</topic><topic>Ejaculation - physiology</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>midodrine</topic><topic>Midodrine - therapeutic use</topic><topic>Nephrology. Urinary tract diseases</topic><topic>Nervous system (semeiology, syndromes)</topic><topic>Neurology</topic><topic>penile vibratory stimulation</topic><topic>Physical Stimulation - methods</topic><topic>Predictive Value of Tests</topic><topic>Retrospective Studies</topic><topic>Sexual Dysfunction, Physiological - etiology</topic><topic>Sexual Dysfunction, Physiological - therapy</topic><topic>Spinal Cord Injuries - complications</topic><topic>spinal cord injury</topic><topic>Treatment Outcome</topic><topic>Vibration - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Courtois, Frédérique J.</creatorcontrib><creatorcontrib>Charvier, Kathleen F.</creatorcontrib><creatorcontrib>Leriche, Albert</creatorcontrib><creatorcontrib>Vézina, Jean‐Guy</creatorcontrib><creatorcontrib>Côté, Magalie</creatorcontrib><creatorcontrib>Bélanger, Marc</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>BJU international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Courtois, Frédérique J.</au><au>Charvier, Kathleen F.</au><au>Leriche, Albert</au><au>Vézina, Jean‐Guy</au><au>Côté, Magalie</au><au>Bélanger, Marc</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Blood pressure changes during sexual stimulation, ejaculation and midodrine treatment in men with spinal cord injury</atitle><jtitle>BJU international</jtitle><addtitle>BJU Int</addtitle><date>2008-02</date><risdate>2008</risdate><volume>101</volume><issue>3</issue><spage>331</spage><epage>337</epage><pages>331-337</pages><issn>1464-4096</issn><eissn>1464-410X</eissn><abstract>Associate Editor
Michael G. Wyllie
Editorial Board
Ian Eardley, UK
Jean Fourcroy, USA
Sidney Glina, Brazil
Julia Heiman, USA
Chris McMahon, Australia
Bob Millar, UK
Alvaro Morales, Canada
Michael Perelman, USA
Marcel Waldinger, Netherlands
OBJECTIVES
To explore the effectiveness of various sources of self‐stimulation, including oral midodrine, in triggering ejaculation in men with spinal cord injury (SCI), and to document the systematic variations in blood pressure at ejaculation and consider a revised definition of autonomic dysreflexia.
PATIENTS AND METHODS
The study included 62 men with SCI lesions from C2 to L2. Ejaculation potential was assessed with various sources of stimulation, beginning with natural stimulation, followed, if the test was negative, by penile vibrator stimulation (PVS) followed, if the test was again negative, by PVS combined with oral midodrine, started at 5 mg and increased in 5 mg steps up to 25 mg. The success rate of ejaculation was recorded, as were blood pressure (BP) changes measured at baseline and at ejaculation (or on the last trial if the test was negative). Reported sensations were also recorded and compared during positive and negative tests.
RESULTS
Overall, 89% of the patients reached ejaculation with one mode or another of stimulation. When patients had a negative result with natural stimulation, 56% were salvaged by PVS, and when PVS was negative, another 22% were salvaged by midodrine combined with PVS. The mean systolic BP increased by 35 mmHg at ejaculation during PVS and by 11 mmHg after midodrine, and a subsequent 29 mmHg at ejaculation during PVS combined with midodrine. By contrast, negative tests showed a relatively stable BP; the difference in changes in BP during positive and negative tests was significant (P < 0.01). Increases in BP during positive tests declined significantly more often within the limits of autonomic dysreflexia than negative tests (P < 0.01).
CONCLUSION
These results support the view that most men with SCI can obtain an ejaculation when a wide spectrum of stimulation is used, including natural stimulation, PVS, and PVS combined with oral midodrine. Positive tests were associated with significant increases in BP, in contrast to negative tests, where BP was relatively stable. This suggests that significant changes in BP are required for ejaculation and that insignificant changes are predictive of future failure. As most changes in BP during positive tests also fall within the criterion of autonomic dysreflexia, a revised definition of autonomic dysreflexia should be considered to encourage safe experiences with ejaculation and safe use of midodrine.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>17922856</pmid><doi>10.1111/j.1464-410X.2007.07254.x</doi><tpages>7</tpages></addata></record> |
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| ispartof | BJU international, 2008-02, Vol.101 (3), p.331-337 |
| issn | 1464-4096 1464-410X |
| language | eng |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Adolescent Adrenergic alpha-Agonists - therapeutic use Adult Aged autonomic dysreflexia Autonomic Dysreflexia - etiology Autonomic Dysreflexia - prevention & control Biological and medical sciences Blood Pressure - drug effects Blood Pressure - physiology Cerebrospinal fluid. Meninges. Spinal cord ejaculation Ejaculation - drug effects Ejaculation - physiology Humans Male Medical sciences Middle Aged midodrine Midodrine - therapeutic use Nephrology. Urinary tract diseases Nervous system (semeiology, syndromes) Neurology penile vibratory stimulation Physical Stimulation - methods Predictive Value of Tests Retrospective Studies Sexual Dysfunction, Physiological - etiology Sexual Dysfunction, Physiological - therapy Spinal Cord Injuries - complications spinal cord injury Treatment Outcome Vibration - therapeutic use |
| title | Blood pressure changes during sexual stimulation, ejaculation and midodrine treatment in men with spinal cord injury |
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