Chapter 1
Retrograde ejaculation
What is Retrograde Ejaculation?
Retrograde ejaculation is a medical disorder when semen enters the bladder instead of going out through the urethra during ejaculation.
Retrograde ejaculation (RE) occurs when the semen passes into the bladder rather than along the urethra.
Retrograde ejaculation is uncommon.
RE is a common type of ejaculatory dysfunction, but accounts for 0.3%-2% of infertility of males.
This condition is marked by significant retrograde propulsion of seminal fluid into the bladder
The bladder neck in the normal physiological condition closes with high pressure during ejaculation, forcing semen deposited into the posterior part of the urethra to flow forward through the urethra and out the urethral meatus
It most often occurs when the bladder neck opening does not close.
This causes semen to go backwards into the bladder rather than forwards out of the penis.
What are the causes of Retrograde Ejaculation?
Causes
Retrograde ejaculation is common in the following situations:
1. After most transurethral resections of the prostate
2. After 40% of bladder neck incisions
Retrograde ejaculation may be caused by:
1. Diabetes
2. Some medicines including, drugs used to treat high blood pressure and some mood-altering drugs
3. Medicines or surgery to treat prostate or urethra problems
With impaired or absent bladder neck closure, semen in the early part of the urethra may be propelled along the path of least resistance into the bladder
The underlying causes of RE may be classified into pharmacological, neurogenic and anatomic causes
1. Pharmacologically-induced RE, is largely caused by psychotropic medications and alpha-adrenergic blockers
2. Neurogenic causes are spinal cord problems, surgical causes (such as lumbar sympathectomy, aortoiliac vascular surgery, retroperitoneal lymph node dissection (RPLND), and abdomino-perineal resection), and neuropathies (such as multiple sclerosis and diabetic autonomic neuropathy)
3. Anatomic etiologies can be subdivided into:
a. Congenital (utricular cysts, posterior urethral valves, and exstrophy)
b. Acquired conditions
i. These are more common and normally result from mechanical blockage of the bladder neck and prostate
ii. About 30% -41% of men report new-onset RE following transurethral removal of the prostate and transurethral laser vaporization of the prostate, respectively
Four causes collectively account for more than 80% of cases.
These factors are
1. DM,
2. Prior history of RPLND,
3. Bladder neck surgery and
4. Transurethral resection of the prostate
What are the symptoms of Retrograde Ejaculation?
Symptoms are:
1. Cloudy urine after orgasms
2. Little or no semen is released during ejaculation
How is Retrograde Ejaculation diagnosed?
Diagnosis:
Presumptive diagnosis of RE is often done by taking a thorough patient history with attention to co-morbid medical disorders, medicines and history of surgical procedure.
In men who have a history of absent or low-volume ejaculate, RE and ejaculatory duct blockage are the 2 possible diagnoses
Patients with RE frequently observe the appearance of post-orgasmic urine to be cloudy.
Diagnosis of RE is made by the results of a post-ejaculatory voided urine that shows spermatozoa, seminal fluid or fructose
A urinalysis that is taken soon following ejaculation will show a large number of sperm in the urine.
What is the treatment of Retrograde Ejaculation?
Treatment
1. The doctor may recommend that the man stop taking any medicines that may potentially induce retrograde ejaculation.
This can resolve the problem.
2. Neurological causes of RE, such as spinal cord injury, are not responsive to medical treatment
TABLE OF CONTENT
Introduction
Chapter 1 Retrograde Ejaculation
Chapter 2 Causes
Chapter 3 Symptoms
Chapter 4 Diagnosis
Chapte
