Læknablaðið : fylgirit - 01.06.2009, Blaðsíða 18

2 7 T H CONGR SCAND ASSOC UROL
F Y L G I R I T 6 1
cumbersome and that is why these patients must not be
neglected. There is often a doctor's delay when these patients
seek medical attention for their symptoms. It is therefore
of paramount importance that unexpected symptoms after
pelvic surgery are thoroughly investigated in order to rule out
complications.
27 Vibratory ejaculation in 169 spinal cord injured men
and home insemination of their partners
J Sanksen1, D Löchner-Ernst2, N Brackett3, D Ohl4, C Lynne3
'Dept ofUrology, Herlev Hospital, University ofCopenhagen, Denmark, 2BC-
Unfallklinik Murnau, Murnau, Cermany, 3The Miami Project to Cure Paralysis,
University of Miami Miller School ofMedicine, Miami, Florida, USA, 4Dept of
Urology, University ofMichigan, Ann Arbor, Michigan, USA
sonksen@mail.dk
Aim: An ejaculation and impairment of semen quality are
commonly found in men after spinal cord injury (SCI). Over
the past several decades, clinical treatments and assisted
reproductive techniques have been developed allowing SCI men
to father children. However, only very few home pregnancies
have been reported in the literature. The aim of this study is
to present the last 20 years' experience from penile vibratory
stimulation (PVS) and vaginal self-insemination at home in SCI
men and their partners. The data originate from two European
and two American centers.
Material and methods: Men with SCI and their healthy female
partners seeking treatment for infertility were evaluated for
this study. Antegrade ejaculation was induced by PVS and
basic semen analysis was performed (WHO criteria). Only
men who had motile sperm in the ejaculate were included. The
main outcome measures were total motile sperm count, time to
pregnancies, numbers of pregnancies and miscarriages.
Results: A total of 169 SCl men (rnedian age 32 yrs, range 22-
44) and their partners (median age 29 yrs, range 19-36) met the
inclusion criteria and were included in the study. The median
total motile sperm count was 31 million (range 1-426). Overall,
73 of the 169 couples (43%) achieved 99 pregnancies with
delivery of 90 healthy babies (88 singletons and 1 pair of twins).
The median time to pregnancy was 1.2 years (range 0.1-8.2). A
total of 10 miscarriages in 9 couples were noted
Conclusion: Based on the largest study of its kind to date, it
is concluded that PVS combined with vaginal self-insemination
may be performed as a viable, inexpensive option for assisted
conception in couples in whom the SCI male partner has adequate
semen parameters and the female partner is healthy.
28 Effects of repeated botulinum toxin therapy in
neurogenic detrusor overactivity
V Karadzic, L Malmberg
Departmcnt ofUrology, Clinical Sciences, Lund, Sweden
violetta.karadzic@skane.se
Aim of investigation: Injection therapy with Botulinum toxin
A (BTX-A) is increasingly used in patients with neurogenic
detrusor overactivity (NDO) who fail conservative treatment.
We evaluated the results of repeated therapy.
Subjects and methods: Patients with NDO who subjectively
had severe urinary incontinence and/or urgency in spite of
conservative treatment were included. 19 men and 10 women
were screened for treatment with 300 U of BTX-A (Botox®).
Causes of neurogenic dysfunction were: Spinal cord injury, MS,
cerebrovascular lesion or Parkinson's disease.
Results and discussion: Mean number of wet pads per week
decreased from 17 before treatment to 7 after. Number of
incontinence-free days per week increased from 3 to 5. Eight
out of 11 patients who had indwelling catheter due to severe
symptoms became catheter-free. Disease specific quality of
life significantly increased from I-Qol-score 47 to 70. A similar
increment was noticed after re-injection. Median time between
treatments was 320 days. No serious adverse events were
reported. Two patients with high spinal cord injuries and
marked autonomic dysreflexia reported weakness in the arms
and shoulders.
Conclusions: Repeated detrusor injection treatment with BTX-A
seems to be very effective in reducing symptoms of neurogenic
detrusor overactivity and, thereby, increasing patient's quality
of life. The rate of adverse events is low. Patients with high
spinal cord lesions and autonomic dysreflexia should be
carefully advised.
29 The very first voidings in life: Urinary flow pattern in
premature boys
LH Olsen, I Grothe, YF Rawashdeh, TM Jorgensen
Paediatric Urology, Dept. Urology, Aarhus University Hospital Skejby, Aarhus,
Denmark
h-olsen@dadlnct.dk
Aim of the study: The voiding of healthy newborn boys shortly
after term is dominated by dyscoordinated flow patterns and
continues to do so during the first year of life. This study ad-
dresses the flow patterns of premature boys.
Subjects and Methods: The parents of 29 otherwise healthy pre-
mature males accepted to let their child participate in the study.
Flow measurements were carried out using an ultrasound flow
probe device during a 4-hour observation period. Flow patterns
were assessed according to the definitions of the ICCS. Data of 25
boys (median gestational age/weight at birth: 31.3 weeks/1590
g) with 98 micturitions where applicable for analysis. Results are
reported as median (range).
Results: On examination median age was 10 (3-42) days. Flow
patterns were bell-shaped in 48%, interrupted in 44%, staccato
in 6% and plateau in 2%. In nine of the 47 bell-shaped curves
(19%) some fluctuations occurred though not fulfilling the
criteria of staccato. None of the premies with more than one re-
corded micturition had bell-shaped curves only. The number of
coordinated flows was not correlated to the age (r: 0.016, P=0.6).
Subjects voided 0.7 (0.2-3.6) times/hour with a volume of 3.9
(0.6-25.2) mL. Median Qmax was 1.0 (0.3-10.0) mL/s.
18 LÆKNAblaðið 2009/95