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  • Fertilité et Sexualité du Paraplégique
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Physiopathologie des troubles de l’érection chez l’homme paraplégique

Physiopathology of erectile dysfunction in paraplegie patients

Andrologie volume 4, pages 129–132 (1994)Cite this article

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Les mécanismes périphériques de l’érection sont dépendants d’un contrôle nerveux complexe mettant en jeu des voies nerveuses périphériques, des boucles réflexes médullaires et des structures nerveuses supramédullaires. Les lésions médullaires modifient tout ou partie de ces contrôles. Selon la nature réflexe ou psychogénique de l’érection, la lésion médullaire n’a pas les mêmes conséquences. Les érections réflexes persistent après des lésions médullaires suprasacrées. Après des lésions au dessous du niveau thoracolombaire, la possibilité de tumescences psychogènes est conservée. Les hypothèses qui expliquent ces différences sont présentées. Elles s’appuient sur des données expérimentales obtenues chez l’animal, et également sur des observations cliniques. Le développement récent de modèles animaux et la meilleure connaissance du rôle du système nerveux dans l’érection par l’étude des voies nerveuses et des neuromédiateurs qu’elles libèrent permet une approche plus analytique des phénomènes et la recherche de mécanismes de compensation en cas de lésions médullaires.

Abstract

Peripheral mechanisms responsible for penile erection are dependant upon a complex control by the nervous system, including peripheral nervous pathways, spinally mediated reflex loops and supraspinal nervous structures. Spinal cord injury is accompanied by a partial or a complete modification of these controls. In relation to the reflexogenic or psychogenic origin of penile erection, spinal cord injury does not cause the same effects. Reflexogenic erections sitll occur after spinal cord injury at a suprasacral level. After lesions at a level lower than the thoracolumbar spinal cord, tumescence following psychogenic stimulation has been observed. The hypotheses resulting from clinical and experimental observations and explaining the differences at the origin of these response are detailed. The recent developments in the neurophysiology of penile erection and the role of neurotransmitters allow a more analytical approach of the phenomenous and also bring new insights into possible compensatory pathways following spinal cord injury.

References

  1. BENOIT G., GIULIANO F.: Anatomie du pénis, des organes érectiles et de l’urètre. Encycl. Med. Chir. Ed. Techniques, Paris, France Nephrologie-Urologie, 18-300-B-10, 1993, 8 p.

  2. BONDIL P., WESPES E.: Anatomie et physiologie de l’érection. Muscles striés et érection. Rapport du 86ème Congrès de l’Association Française d’Urologie 1992. Progrès en Urologie, 1992, 2: 809–824.

  3. BORS E., COMARR E.: Neurological disturbances of sexual function with special reference to 529 patients with spinal cord injury. Urol. Surv. 1960, 10: 191–222.

    Google Scholar 

  4. CHAPELLE P.A., DURAND J., LACERT P.: Penile erection following complete spinal cord injury in man. Brit. J. Urol. 1980, 52: 216–219.

    Article  CAS  PubMed  Google Scholar 

  5. COURTOIS F., CHARVIER K. LERICHE A.: Sexual function in paraplegia: 1 assessing sexual capacity. Paraplegia, 1994, sous presse.

  6. COURTOIS F., LERICHE A.: L’examen sexologique du blessé médullaire. Prog. Urol. 1991, 1: 1056–1063.

    CAS  PubMed  Google Scholar 

  7. COURTOIS F., MC DOUGLALL J.C., SACHS B.D.: Erectile mechanisms in paraplegia. Physiol. Behav, 1993, 53: 721–726.

    Article  CAS  PubMed  Google Scholar 

  8. DE GROAT W.C., STEERS W.D.: Neuroanatomy and neurophysiology of penile erection. In: Tanagho E.A., Lue T.F. and Mc Clure R.D. eds Contemporary management of impotence and infertility. Williams & Wilkins, Baltimore, 1988: 3–27.

    Google Scholar 

  9. GIULIANO F., RAMPIN O., BENOIT G., JARDIN A.: Commande nerveuse périphérique de l’érection. Andrologie. 1993, 2: 123–127.

    Article  Google Scholar 

  10. GIULIANO F., RAMPIN O., JARDIN A., ROUSSEAU J.P.: Electrophysiological study of relations between the dorsal nerve of the penis and the lumbar sympathetic chain in the rat. J. Urol, 1993, 150: 1960–1964.

    CAS  PubMed  Google Scholar 

  11. HART B.L.: Sexual reflexes and mating behavior in the male rat. J. Comp. Physiol. Psychol, 1968, 65: 453–460.

    Article  CAS  PubMed  Google Scholar 

  12. LERICHE A.: Les troubles génito-sexuels dans la paraplégie. J. Méd. Lyon, 1989, 1452: 275–278.

    Google Scholar 

  13. LIU Y.C., SALAMONE J.D., SACHS B.D.: Psychogenic erection in rats: effects of lesions in medial preoptic area, paraventricular nucleus and pelvic and hypogastric nerves. Soc. Neurosci. Abstr, 1993, 19: 585.

    Google Scholar 

  14. MC KENNA K.E., NADELHAFI J.: The pudentopudental reflex in male and female rats. J. Autonom. Nerv. Sys, 1989, 27: 67–77.

    Article  CAS  Google Scholar 

  15. PESCATORI E.S., CALABRO A., ARTIBANI W., PAGANO F., TRIBAN C., ITALIANO G.: Electrical stimulation of the dorsal nerve of the penis evokes reflex tonic erections of the penile body and reflex ejaculatory responses in the spinal rat. J. Urol, 1993, 149: 627–632.

    CAS  PubMed  Google Scholar 

  16. RIVAS D.A., CHANCELLOR M.B., ERHARD M.J., HUANG B., HIRSCH B., HIRSCH J.H., SALZMAN S.K.: Comparison of erectile response to intraurethral, topical and intracorporal pharmacotherapy in the rat model of spinal cord injury. Am. Urol. Ass. Abstr. J. Urol, 1994, 151: 495A.

    Google Scholar 

  17. ROOT W.S., BARD P.: The mediation of feline erection through sympathetic pathways with some remarks on sexual behavior after deafferentation of the genitalia. Am. J. Physiol, 1947, 151: 80–90.

    CAS  PubMed  Google Scholar 

  18. SACHS B., GARINELLO L.D.: Hypothetical pacemaker regulating penile reflexes in rats: evidence from transection of spinal cord and dorsal penile nerves. J. Comp. Physiol. Psychol, 1980, 94: 530–535.

    Article  CAS  PubMed  Google Scholar 

  19. SCHMIDT M.H., SCHMIDT H.S.: The ischiocavernosus and bulbospondiosus muscles in mammalian penile rigidity. Sleep, 1993, 16: 171–183.

    CAS  PubMed  Google Scholar 

  20. STEERS W.D., MALLORY B., DE GROAT W.C.: Electrophysiological study of neural activity in penile nerve of the rat. Am. J. Physiol, 1988, 254: R989-R1000.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Laboratoire de Chirurgie Expérimentale et Service d’Urologie, Hôpital de Bicêtre, 94270, Bicêtre Cédex

    François Giuliano, Pascal Blanchet, Gérard Benoit & Alain Jardin

  2. Laboratoire de Neurobiologie Végétative, I. N. R. A., 78352, Jouy-en-Josas

    Olivier Rampin

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  1. François Giuliano
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  2. Olivier Rampin
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  3. Pascal Blanchet
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  4. Gérard Benoit
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  5. Alain Jardin
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Giuliano, F., Rampin, O., Blanchet, P. et al. Physiopathologie des troubles de l’érection chez l’homme paraplégique. Androl. 4, 129–132 (1994). https://doi.org/10.1007/BF03034277

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Basic and Clinical Andrology

ISSN: 2051-4190