Current concepts, therapies, and recommendations to assist fertility outcomes in male patients with spinal cord injury

Spinal cord injury (SCI) is a prevalent problem, affecting nearly 288,000 people in the United States. Many men with SCI can present with erectile dysfunction (ED), anejaculation, and infertility, imputing profound impacts on quality of life for this population. Erectile dysfunction is generally well managed pharmacologically with phosphodiesterase-5 inhibitors and intracavernous injections or surgically with penile prosthesis. Additional treatment modalities, including vacuum constrictive devices and muscle stimulation, can be used to supplement pharmacological treatment of ED. Anejaculation is a prevalent problem, especially for men seeking to have children, but it is managed well with penile vibratory stimulation, electroejaculation, and testicular sperm extraction. Various sperm abnormalities are also prevalent in this population, with consensual support for the presence of hypospermia, asthenospermia, and necrospermia. Recent literature supports the potential use of probenecid and mirabegron to help improve these sperm abnormalities. The literature most consensually supports a high inflammatory state as the most likely pathological driver behind these sperm abnormalities. In all, ED, anejaculation, and infertility are managed relatively well in men with SCI. More work is needed to better understand the pathophysiology of sperm abnormalities to shed more light on better methods of treatment.