Reflexes and somatic responses as predictors of ejaculation by penile vibratory stimulation in men with spinal cord injury

Study design: Retrospective chart review. Objective: To identify factors in addition to level of injury (LOI) that ma y predict ejaculation 7 by penile vibratory stimulation (PVS) in spinal cor d injured mates. Setting: Major urban medical school and teaching hospital. Materials and methods: Presence of a bulbocavernosus response (BCR) and a h ip flexor response (HR) before PVS (n = 123 patients), and somatic response s during PVS (n = 204 trials performed on a subset of 44 patients) were eva luated for their frequency of occurrence on trials with and without ejacula tion. Results: Overall ejaculation success rates for cervical. T1 - T6. and T7 - T12 LOI were 71%. 73%, and 35%, respectively. Eighty per cent of patients w ho were positive for both BCR and FIR ejaculated with PVS, while only 8% of patients who were negative for both BCR and HR ejaculated with PVS. For ce rvical injuries, BCR and HR were no more predictive of ejaculation by PVS t han LOI alone. T1 - T6 patients were more likely to ejaculate when at least one reflex was present. T7 - T12 patients with no BCR were unlikely to eja culate by PVS. Except for abdominal contractions. somatic responses were no t present in the majority of PVS trials. When they were present, however. t hey occurred in a high percentage of ejaculation trials: withdrawal respons e (hip flexion. knee flexion and thigh adduction) (90%), piloerection (84%) , extremity spasms (83%), thigh abduction (80%), and thigh adduction (72%). Conclusion: We recommend that patients with cervical injuries initially und ergo PVS. Patients with T1 - T6 LOI with at least one reflex present, and p atients with T7 - T12 LOI with both reflexes, or only BCR present, may unde rgo PVS. Certain somatic/autonomic responses, when seen, may help in decidi ng whether to continue with a given trial, or give a repeat trial, of PVS. Sponsorship: The Miami Project to Cure Paralysis and the State of Florida S pecific Appropriations.