An Audit of Andrological Needs in Traumatic Paraplegic Male Patients: Five Year Assessment in a Single Paraplegic Centre
Dr. Sunil Patil,
Room No. 219, Department of Urology, Lokmanya Tilak Medical College and General Hospital, Mumbai-22, Maharashtra, India.
Introduction: Management of andrological needs of paraplegic patients is challenging and has to be individualised.
Aim: To analyse demographic profile and treatment responses with respect to the andrological needs in Traumatic Spinal Cord Injury (TSI) patients over five years in a single paraplegic centre.
Materials and Methods: Records of 110 patients admitted for TSI over a period of five years were studied. Demographic parameters considered were age, marital and fertility status, mode of trauma, socioeconomic status. Patients were assessed by American Spinal Injury Association Impairment Scale (AIS) and International Index of Erectile Function score (IIEF5). Erectile Dysfunction (ED) and Ejaculatory Dysfunctions (EJD) were primarily targeted for interventions. Treatment options included were Phosphodiesterase-5 inhibitors (PDE-5i), Intracavernosal Injections of Vasoactive Drugs (ICIVAD) and Vacuum Erection Devices (VED) for ED; Penile Vibrator Stimulation (PVS) and Electroejaculation (EEJ) for EJD. All the interventions were also accompanied by psychosexual counseling.The proportion of patients responding to each therapy was noted. Paired t-test was used to compare the IIEF score in patients with ED before and after therapy.
Results: Seventy four patients were addressed for ED. The mean age was 31.3±7.8 years; 58 of 74 patients were compliant for PDE-5 inhibitors; 42 patients out of these were satisfied with oral PDE-5i therapy. Out of 12 patients who opted for ICIVAD, 10 were satisfied with the outcome. Out of 16 patients treated by VED, 5 deemed their erections as satisfactory. The mean IIEF-5 score before therapy was 8. The mean IIEF-5 score as a result of the combined therapy was 12.3 (p<0.01). Total 16 patients had EJD, out of which 5 had successful ejaculation after PVS. One patient underwent successful Electro-ejaculation.
Conclusion: A step-by-step approach of oral PDE-5i therapy, ICIVAD and VED is adequate to manage ED in a majority of patients with SCI. Similarly, PVS and EEJ can be used for management of EJD in these patients.