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those that are medical and occur through disruption of the normal physiologic processes, through disease, trauma, surgery, medication and so on Pathophysiologic causes of RE are far more readily identi able and generally surface during a medical history and examination They typically stem from predictable sources: anomalous anatomic, surgical, neuropathic, endocrine, and medication (iatrogenic) For example, surgical therapy for prostatic obstruction is likely to disrupt bladder neck competence during emission All types of IE show an agerelated increase in prevalence and increased severity, with lower urinary tract symptoms independent of age [77,78] Commonly-used medications, particularly antidepressants, may centrally inhibit or delay ejaculation as well [79] The ability to ejaculate is severely impaired by spinal cord injury (SCI) and is dependent upon the level and completeness of SCI [80] Unlike erectile capacity, the ability to ejaculate increases with descending levels of spinal injury [81] (Table 162) Less than 5% of patients with complete upper motor neuron lesions retain the ability to ejaculate Semen for use with arti cial reproductive techniques may be obtained from men with SCI by vibratory stimulation, electro-ejaculation, or percutaneous aspiration of semen from the vas deferens [82 84] Testicular biopsies in spinal cord injured men demonstrate a wide range of testicular dysfunction, and sperm density and motility are higher in men with incomplete lesions [85] More dif cult to identify are inherent physiologic factors that account for variation in ejaculatory latency and thus might play a role in IE (particularly vb.net barcode generator source code ZintNET - Barcode Library download | SourceForge. net
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