ELECTROEJACULATION VERSUS VIBRATORY STIMULATION IN SPINAL-CORD INJURED MEN - SPERM QUALITY AND PATIENT PREFERENCE

Purpose: We compared semen quality and patient preference between peni le vibratory stimulation and electroejaculation in spinal cord injured men. Materials and Methods: We treated 11 spinal cord injured men wit h penile vibratory stimulation and electroejaculation in random order. End points examined were semen analysis, sperm functional assessment, and patient pain scores (1 to 10) and preferred procedure. Difference s between the procedures were determined with the paired Student t tes t. Results: There was no difference in antegrade sperm count but penil e vibratory stimulation specimens had greater motility (26.0 versus 10 .7%), viability (25.2 versus 9.7%) and motile sperm count (185.0 x 10( 6) versus 97.0 x 10(6)). The retrograde sperm count was greater (but n ot significant) in electroejaculation patients. The total (antegrade p lus retrograde) and motile sperm counts were not different. There was no difference in immunobead test (all negative), cervical mucus penetr ation or sperm penetration assay, although the percent hamster egg pen etration approached significance (53.7% for penile vibratory stimulati on versus 22.1% for electroejaculation, p = 0.06). There was no differ ence in the peak blood pressures and no complications were noted. Pain scores were significantly greater for electroejaculation compared to penile vibratory stimulation (5.2 versus 1.7, respectively). All patie nts preferred penile vibratory stimulation. Conclusions: There was a s light advantage in sperm quality and a high patient preference in favo r of penile vibratory stimulation. Penile vibratory stimulation should be attempted first to induce ejaculation in spinal cord injured men, with electroejaculation reserved for failures.