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An abstract of the article "Male fertility and sexual function after spinal cord injury," by D. J. Brown and others is presented.

Spinal cord injury has an enormous impact upon the sexual relationship of a man and his partner. Erection may be partial or absent, orgasm altered or impossible, and fertility severely impaired. New understanding of the physiology of sexual function and improved treatment can enable most cord-injured men to achieve erections suitable for sexual satisfaction. Modern methods of sperm collection and fertility treatment mean that many can also be fathers. The best results are obtained by a team approach involving rehabilitation and reproductive medicine clinicians, nurses, spinal cord injury specialists and counselors with the cord-injured man and his partner. Erections can be achieved by drugs, such as sildenafil, that block phosphodiesterase 5, prolonging the action of nitric oxide with resultant smooth muscle relaxation. Intracavernosal prostaglandin E1 and mechanical systems, such as vacuum pumps and constriction rings, are also effective. Sexual gratification can be promoted in the context of an understanding relationship in which the cord-injured person can gain pleasure from pleasing his partner and also from his partner's exploration of erotogenic areas not affected by the spinal cord injury. An emphasis on the broader view of sexuality in relationships allows for a continuance and strengthening of bonds between the couple. Vibration ejaculation or electroejaculation can be used to collect semen. For a limited period in the acute phase, usually for about 6-12 days after injury, normal semen can be obtained by electroejaculation from some cord-injured men. With chronic spinal cord injury the semen is of variable quality. Some patients have necrospermia, which may be improved by regular ejaculation. Others have poor quality semen or spermatogenic disorders and, in this situation, in vitro fertilization techniques must be used to achieve parenthood. Trials of assisted ejaculation help individualize cost-effective management of the infertility.

Study Design: Retrospective review of patient data., Objective: To present two years of experience in the use of gabapentin for the alleviation of neuropathic pain in spinal cord injury patients., Setting: Supra-regional Spinal Cord Service, Melbourne, Australia., Method: Data were retrieved from the medical records of all spinal cord injury patients prescribed gabapentin for neuropathic pain. Pain was assessed prior to and during treatment at 1, 3 and 6 months with a 10 cm visual analogue scale which ranged from 0 ('no pain') to 10 ('worst pain imaginable'), or by the documentation of a verbal description of pain., Results: Seventy-six per cent of patients receiving gabapentin reported a reduction in neuropathic pain. In those patients with data at all four measurement points, the mean pretreatment score was 8.86. Following treatment with gabapentin the score dropped to 5.23, 4.59 and 4.13 at 1, 3 and 6 months, respectively. Where only a verbal description of pain was documented, the trend was that the pretreatment report of 'unbearable' was replaced by 'liveable' during treatment., Conclusion: Our experience suggests that gabapentin offers an effective therapeutic alternative for the alleviation of neuropathic pain following spinal cord injury. Controlled clinical trials are now required to confirm these observations.

Study Objective: To assess laparoscopic-assisted vaginal hysterectomy (LAVH) by operative intervention, recovery time, morbidity, and patient satisfaction., Design: A retrospective, cohort study conducted from 1990 to 1992., Setting: Two community hospitals., Patients: One hundred seventy-eight women thought to require abdominal hysterectomy., Interventions: Three gynecologic surgeons performed the LAVHs. For each case, several features were tabulated and final pathologic diagnoses were recorded. Patient satisfaction was measured by survey. Data were divided into three time epochs, early, middle, and late, and the outcomes were compared. We also measured the impact of LAVH on th number of abdominal hysterectomies., Measurements and Main Results: The mean operative time was 119.4 minutes (SD 34.1 min). The mean uterine weight was 153.4 g (SD 100.3 g), and only 29 patients (16.3%) had no pathologic condition. The mean length of hospital stay was 1.3 days (SD 0.92 days) and diminished over the 2 years of the study. Mean hemoglobin decrement was 2.6 g (SD 1.2 g). Thirteen patients had complications other than febrile morbidity and seven had febrile morbidity, for an overall complication rate of 11.2% There were no significant differences in blood loss, complication rate, uterine weight, or operative time among the three epochs. One hundred thirty-two patients (73.0%) responded to the survey and expressed high satisfaction. The proportion of hysterectomies performed abdominally diminished over the course of the study., Conclusions: Morbidity associatd with LAVH was similar to that reported for vaginal hysterectomy. The lack of controls precludes knowing whether patient satisfaction was related to type of procedure. Randomized, controlled trials of women not considered candidates for vaginal hysterectomy are necessary to assess this procedure.

In chronic spinal cord injury, semen obtained by assisted ejaculation is usually abnormal. We have assessed electroejaculation early after injury in seven patients. There were no adverse effects. Initial samples contained few or no spermatozoa but as patients emerged from spinal shock, semen improved and five had specimens cryopreserved. Thereafter sperm motility and viability decreased towards the pattern of chronic spinal cord injury by day 16. Cryopreservation was not possible in one patient with many medical complications and another who started electroejaculation 15 days after injury. Semen storage within the first 2 weeks after spinal cord injury is recommended for future fertility treatment.

The aim of this study was to develop a technique which would prevent retrograde ejaculation in chronic spinal cord injured (SCI) patients undergoing vibration and electroejaculation procedures. A balloon catheter was used to tamponade the bladder neck in 12 patients who underwent 100 assisted ejaculation procedures. Antegrade ejaculations were collected on all occasions with no incidences of urine contamination and no sperm were seen in post ejaculatory urine. Silicone catheters had minimal effects on sperm motility and viability. All lubricant gels were found to adversely affect sperm quality and were not used.

To determine whether infants who are properly dried and wrapped can be held and warmed by parents in the delivery room without suffering a significant heat loss, temperatures of 100 infants were monitored with electronic thermometers after delivery; 50 were held by one or both parents and 50 were not held but immediately placed in a heated transporter. A two-tailed t test showed no significant differences between temperatures of the two groups.

The number of units of blood preoperatively crossmatched to the number of units transfused was studied retrospectively in patients undergoing four common obstetric and gynecologic procedures. Associated medical problems and the timing of and reasons for transfusions were evaluated. Patients with risk factors associated with an increased incidence of required transfusion were identified. Based on these results, a type and screen method for preoperative blood ordering is recommended for most patients undergoing cesarean section, abdominal hysterectomy, and vaginal hysterectomy. Using this method, sera are preoperatively tested for unexpected antibodies and ABO/Rh typing is done. If the antibody screen is negative, crossmatching is not done. Should a transfusion be ordered, crossmatching can be done in 20 minutes, or type-specific blood can be available after a 15-second saline spin. Through application of the type and screen method, a substantial savings in money and laboratory personnel time can be expected without compromising patient care.