SCI-13 · Sexuality, Fertility, and Reproductive Health

Sexuality, Fertility, and Reproductive Health. Part of the Spinal Cord Injury series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: Because of this damage, leukocytospermia is considered the single worst predictor of male infertility in this population. It is the dominant negative factor. — Correct: Leukocytospermia (more than 1 million white blood cells per milliliter) is a traditional board association with impaired ovum penetration and can contribute to oxidative sperm damage. It is not a validated single strongest predictor of every fertility endpoint, and it is not a live-birth predictor. Confirm that the round cells are leukocytes rather than germ cells, evaluate for infection and treat a demonstrated infection, and discuss sperm processing and assisted reproduction with specialists. The treatment sentences that follow also overstate the case: do not prescribe antibiotics or antioxidants routinely for the white-cell threshold alone, and white-cell normalization is not a prerequisite for proceeding to assisted reproduction. The claim is restated in the closing recap. (2) In the audio: Succinylcholine is permanently contraindicated starting 48 hours after a spinal cord injury. That risk does not fade with time. It is an indefinite permanent contraindication for the rest of their life. — Correct: Avoid succinylcholine after the acute phase of spinal cord injury with denervation or upper motor neuron injury, because it can cause life-threatening hyperkalemia, and use a non-depolarizing agent instead. That much is right, and so is the extrajunctional-receptor mechanism. The permanence claim is not. The label states that the hyperkalemia risk peaks around 7 to 10 days and that the exact onset and duration are undetermined, so no fixed later interval establishes safety, which is not the same as proven permanent receptor upregulation in every patient. The practical rule is unchanged: do not use it, and equally, do not clear a chronic injury for succinylcholine on elapsed time alone. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/SCI-13.