Severe hypertension in patients with high spinal cord lesions undergoing electro-ejaculation--management with prostaglandin E2.

Intra-arterial blood pressure (BP) and heart rate (HR) were continuously recorded in five patients with spinal cord injuries at different levels who were undergoing electro-ejaculation. In three patients with lesions at C7, C5 and T4 insertion of the electrode and electrical stimulation caused severe hypertension and bradycardia. In a patient with a T7/8 lesion and in another with a T10 lesion there were either moderate or minimal cardiovascular changes. Severe hypertension during electro-ejaculation is a serious problem in patients with high lesions and is probably part of the syndrome of autonomic dysreflexia. In the three patients with high spinal cord lesions the procedures were repeated during an intravenous infusion of Prostaglandin E2. Resting BP was lowered and resting HR raised. The level of BP recorded during electrical stimulation was substantially reduced. This enabled larger stimuli to be used for a longer period and resulted in successful ejaculation in two patients.