Spinal kord yaralanmalı erkek ve kadın hastalarda cinsel fonksiyon bozuklukları: Klinik ve elektrofizyolojik değerlendirme
Küçük Resim Yok
Tarih
2005
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/closedAccess
Özet
8. ÖZET Bu çalışmanın amacı, spinal kord yaralanmalı kadın ve erkek hastalarda cinsel fonksiyon bozukluklarının hasta bildirimleri, klinik nörolojik muayene ve elektrofizyolojik incelemelerle ortaya konmasıdır. Bu amaçla çalışmaya spinal şok döneminden çıkmış 30'u erkek, 13'ü kadın toplam 43 spinal kord yaralanmalı hasta dahil edildi. Tüm hastalar formlar aracılığıyla sorgulanarak, yaralanma bilgilerinin yanı sıra, yaralanma öncesi ve sonrası cinsel fonksiyonları hakkında ayrıntılı bilgi elde edildi. Hastalar ayrıca, ilaç kullanımı, spastisite, alt ekstremitede güçsüzlük, otonom disrefleksi, cinsel ilişki sırasında idrar inkontinansı gibi cinsel fonksiyona olumsuz etkisi olabilecek faktörlerlerle ilgili ayrıntılı olarak sorgulandı. Erkekte erektil fonksiyon; International Index of Erectile Function (IIEF-5) ile, kadında cinsel fonksiyon; Female Sexual Function Index (FSFI) ile sayısal olarak değerlendirildi. Depresyon; Zung skalasıyla, genel fonksiyonel durum; FİM ile değerlendirildi. Tüm hastalara ayrıntılı nörolojik muayene yapılarak ASIA protokolüne göre nörolojik seviyeleri belirlendi. Bu seviyeler, cinsel fonksiyondan sorumlu spinal kord merkezlerinin yerleşimine göre Tl O ve üzeri, T11-L2 arası, conus-cauda lezyonu olmak üzere 3 grupta sınıflanarak ereksiyon, ejakülasyon, lubrikasyon ve orgazmla ilgili bilgilerle nörolojik seviye arasındaki ilişkiler araştırıldı. 36 hastada (25 erkek, 11 kadın) ürodinamik incelemeler, 26 hastada (17 erkek, 8 kadın) elektrofizyolojik incelemeler gerçekleştirildi. Elektrofizyolojik incelemeler, bulbokavernöz refleks (BCR), pudendal somatosensöriyel uyartılmış potansiyeller (pSEP) ve perineal sempatetik deri yanıtlarını (pSDY) içermekteydi. Elektrofizyolojik inceleme sonuçlarıyla klinik değerlendirme, ürodinamik inceleme ve cinsel disfonksiyonlar arasındaki ilişkiler araştırıldı. Spinal kord yaralanmalı hastalarda cinsel isteğin, erkeklerde daha fazla olmak üzere büyük ölçüde korunduğu, ancak cinsel ilişkiye girme oranlarının ve sıklığının 73kadınlarda daha belirgin olmak üzere azaldığı görüldü. Hastalar için cinsellik, spinal kord yaralanmasıyla ilgili diğer sorunlar göz önüne alındığında öncelikli bir sorun değildi. Erkeklerde ortalama IIEF-5 skoru 7 ± 6.69 idi. Erkeklerin tümünde bir şekilde ereksiyon kapasitesi korunduğu, ancak ereksiyonlann süre ve sertliğinin yetersiz olduğu görüldü. Tl O ve üzerindeki seviyelerde refleks ereksiyonlar, conus-cauda lezyonlarında ise psikojen ereksiyonlar %100 oranında korunmuştu. Nörolojik seviyesi Tl2 ve altoda olan hastaların tümünde psikojen ereksiyon korunmuştu. Hastaların %43.3'ünde ejakülasyon korunmuştu. Ejakülasyon oranı, Tl O ve üzeri seviyelerde conus-cauda seviyelerine kıyasla daha düşüktü. Ejakülasyonu olan hastaların %76.9'u orgazma ulaştığını bildirdi. Kadınlarda ortalama FSFI skoru 2.35 ± 0.94 olarak bulundu. Kadınlarda az sayıda hastada veri elde edebilmekle birlikte, conus-cauda lezyonu olan hastaların %83.3'ünde psikojen lubrikasyon korunurken refleks lubrikasyonun olmadığı belirlendi. Yine bilgi edinilebilen az sayıdaki kadın hastada orgazmik bozukluğun olduğu belirlendi. Elektrofizyolojik incelemelerden BCR ile refleks ereksiyon arasında istatistiksel anlamlı ilişki saptandı (p<0.05). BCR ile refleks lubrikasyon arasında da benzer bir ilişkinin olabileceği öngörüldü. pSDY ile psikojen ereksiyon arasında istatistiksel anlamlı ilişki bulunurken (p<0.05), pSEP ile cinsel fonksiyonlar arasında herhangi bir ilişki saptanmadı. Nörojenik mesane tipiyle refleks ereksiyon ve BCR arasında istatistiksel anlamlı ilişki vardı (p<0.05). Sonuç olarak bu çalışma, SKY sonrası erkek ve kadınlarda cinsel fonksiyonlarda bozulma olduğunu, geride kalan cinsel kapasitenin tahmininde nörolojik seviyenin cinsel fonksiyonu düzenleyen merkezler esas alınarak sınıflanmasının, nörojenik mesane tipinin ve elektrofizyolojik incelemelerden BCR ve pSDY'nin yeri olduğunu göstermiştir
9. SUMMARY The aim of this study is to determine the sexual function disorders in female and male patients with spinal cord injury by the use of patient reports, clinical neurologic examination and electrophysiological studies. With this scope, 30 male, 13 female patients were enrolled in the study. Detailed information about pre/post-injury sexual function and factors that may have negative effects on sexual function like use of mediactions, spasticity, weakness of the lower extremities, autonomic dysreflexia and urinary incontinence during sexual activity was obtained from the patients via inquiry forms. Depression was evaluated with Zung self rating depression scale, functional state; with FIM, erectile function in men; with IIEF-5 and sexual function in women; with FSFI. Neurologic levels of the patients were determined with ASIA impairment scale. Having classified these levels into 3 groups, namely, T10 and above, T11-L2, conus-cauda according to the alignment of the spinal cord centers responsible of sexual function, the relation between the data about erection, ejaculation, lubrication and orgasm and neurologic level was investigated. The relationship between electrophysiological assessments concerning bulbocavernosus reflex (BCR), pudendal somatosensorial evoked potentials (pSEPs) and perineal sympathetic skin responses (pSSRs), clinical evaluation, urodynamic examination and sexual dysfunction were studied. We observed that sexual desire was preserved in the majority of the spinal cord injured patients, with men occupying a greater ratio. However, it was observed that the ratio and the frequency of participation in sexual activity were decreased in both sexes, particularly in women. Taking all other problems associated with spinal cord injury into account, sexuality was no priority for the patients. Depression scores were similar between patients who have had sex and who haven't. Mean IIEF-5 score was 7 ± 6.69. It was found that at levels of T10 and above; reflex erections were preserved with a 100% ratio. At conus-cauda lesions; while psychogenic erections were preserved with a 75100% ratio, reflex erections were absent. In all patients with neurologic levels at / below T12 psychogenic erections were maintained. Erections were in someway preserved in men, nevertheless the duration and the rigidity of these erections were very insufficient. Ejaculation was present in 43.3% of men. Ejaculation rate was lower in T10 and above levels when compared with conus-cauda levels. 76.9% of the patients with ejaculation also reported orgasm. Mean FSFI score was 2.35 + 0.94. Despite the lack of sufficient data in women, it was determined that in 83.3% of the patients with conus-cauda lesions, psychogenic lubrication was preserved while reflex lubrication wasn't. Orgasmic disorder was noteworthy in a limited number of female patients. Of the electrophysiological examinations studied, BCR showed a statistically significant relationship with reflex erections (p<0.05). It was suggested that such a relationship could also exist between BCR and reflex lubrications. There also was a statistically significant relationship between pSSRs and psychogenic erections (p<0.05), while no relation was observed between pSEPs and sexual function. There was a statistically significant relation between neurogenic bladder type and reflex erections, and between neurogenic bladder type and BCR as well (p<0.05). In conclusion, this study has demonstrated that there is an impairment in sexual function in both sexes after spinal cord injury, and that the classification of neurologic level according to the spinal centers regulating sexual function, the type of neurogenic bladder and the electrophysiological examinations, namely, bulbocavernosus reflex and perineal sympathetic skin responses have an imperative place in the estimation of the remaining sexual function. 76
9. SUMMARY The aim of this study is to determine the sexual function disorders in female and male patients with spinal cord injury by the use of patient reports, clinical neurologic examination and electrophysiological studies. With this scope, 30 male, 13 female patients were enrolled in the study. Detailed information about pre/post-injury sexual function and factors that may have negative effects on sexual function like use of mediactions, spasticity, weakness of the lower extremities, autonomic dysreflexia and urinary incontinence during sexual activity was obtained from the patients via inquiry forms. Depression was evaluated with Zung self rating depression scale, functional state; with FIM, erectile function in men; with IIEF-5 and sexual function in women; with FSFI. Neurologic levels of the patients were determined with ASIA impairment scale. Having classified these levels into 3 groups, namely, T10 and above, T11-L2, conus-cauda according to the alignment of the spinal cord centers responsible of sexual function, the relation between the data about erection, ejaculation, lubrication and orgasm and neurologic level was investigated. The relationship between electrophysiological assessments concerning bulbocavernosus reflex (BCR), pudendal somatosensorial evoked potentials (pSEPs) and perineal sympathetic skin responses (pSSRs), clinical evaluation, urodynamic examination and sexual dysfunction were studied. We observed that sexual desire was preserved in the majority of the spinal cord injured patients, with men occupying a greater ratio. However, it was observed that the ratio and the frequency of participation in sexual activity were decreased in both sexes, particularly in women. Taking all other problems associated with spinal cord injury into account, sexuality was no priority for the patients. Depression scores were similar between patients who have had sex and who haven't. Mean IIEF-5 score was 7 ± 6.69. It was found that at levels of T10 and above; reflex erections were preserved with a 100% ratio. At conus-cauda lesions; while psychogenic erections were preserved with a 75100% ratio, reflex erections were absent. In all patients with neurologic levels at / below T12 psychogenic erections were maintained. Erections were in someway preserved in men, nevertheless the duration and the rigidity of these erections were very insufficient. Ejaculation was present in 43.3% of men. Ejaculation rate was lower in T10 and above levels when compared with conus-cauda levels. 76.9% of the patients with ejaculation also reported orgasm. Mean FSFI score was 2.35 + 0.94. Despite the lack of sufficient data in women, it was determined that in 83.3% of the patients with conus-cauda lesions, psychogenic lubrication was preserved while reflex lubrication wasn't. Orgasmic disorder was noteworthy in a limited number of female patients. Of the electrophysiological examinations studied, BCR showed a statistically significant relationship with reflex erections (p<0.05). It was suggested that such a relationship could also exist between BCR and reflex lubrications. There also was a statistically significant relationship between pSSRs and psychogenic erections (p<0.05), while no relation was observed between pSEPs and sexual function. There was a statistically significant relation between neurogenic bladder type and reflex erections, and between neurogenic bladder type and BCR as well (p<0.05). In conclusion, this study has demonstrated that there is an impairment in sexual function in both sexes after spinal cord injury, and that the classification of neurologic level according to the spinal centers regulating sexual function, the type of neurogenic bladder and the electrophysiological examinations, namely, bulbocavernosus reflex and perineal sympathetic skin responses have an imperative place in the estimation of the remaining sexual function. 76
Açıklama
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Anahtar Kelimeler
Fiziksel Tıp ve Rehabilitasyon, Physical Medicine and Rehabilitation
