Testing sensation of gently squeezing the testes has diagnostic value in spinal cord injury men

STUDY DESIGN: Retrospective cohort study.

OBJECTIVES: Determine the diagnostic value of testing the sensation of squeezing the testes.

SETTING: Research group run by the University of Antwerp.

METHODS: During the clinical examination, it was evaluated if male spinal cord injury (SCI) patients felt gentle squeezing of the testes. The outcome was related to the type of SCI, to the sensations of the light touch of the dermatomes of the perineum, of bladder filling, of overactive detrusor (DOA) contractions during urodynamics, and of electrosensation elicited in different parts of the lower urinary tract. The neurological pathways elicited by these tests were compared.

RESULTS: Seventy-four patients were included, mean age 46 ± 17 years, a number of weeks post SCI 318 ± 586. Sensation in the testes was present in 72.2%. In patients with AIS A, the sensation was found positive in 41%, while all with AIS B-D felt the sensation. Testes sensation was strongly correlated with the sensation of touch of the perineum and with the filling sensation during cystometry, proving a dorsal column pathway. The sensation of DOA contractions and electrosensation in the bladder, bladder neck/proximal, and distal urethra were not significantly related to the outcome of the testicular examination, showing that anterior and lateral spinothalamic pathways were not involved CONCLUSIONS: Our data show that sensation from gently squeezing the testes informs about the dorsal column from spinal cord level T10-L2 upwards. The test can help refine the neurologic diagnosis after SCI. We advocate to include this easy-to-do test in the neuro-urologic clinical examination.