Wsteczny wytrysk – Patofizjologia i mechanizm

Wsteczny wytrysk
Patofizjologia i mechanizm

Wsteczny wytrysk (retrograde ejaculation) to zaburzenie polegające na cofnięciu nasienia do pęcherza moczowego podczas ejakulacji, spowodowane dysfunkcją mięśnia zwieracza szyi pęcherza moczowego. Fizjologicznie, zamknięcie szyi pęcherza pod wysokim ciśnieniem podczas ejakulacji wymusza przepływ nasienia przez cewkę moczową na zewnątrz. Patomechanizm obejmuje zaburzenia układu współczulnego (L1-L2) i przywspółczulnego (S2-S4), które koordynują skurcze mięśni pęcherza i gruczołów płciowych. Przyczyny wstecznego wytrysku są wieloczynnikowe i obejmują neuropatie (np. cukrzycowa neuropatia autonomiczna z częstością do 32%), uszkodzenia nerwów pooperacyjne (np. TURP, operacje zaotrzewnowe), farmakoterapię (alfa-adrenolityki takie jak tamsulosin, silodosin, leki przeciwpsychotyczne) oraz czynniki endokrynologiczne (np. niedoczynność tarczycy). Diagnostyka opiera się na wykryciu plemników w moczu po ejakulacji, a potwierdzenie uzyskuje się poprzez analizę próbki moczu pobranej bezpośrednio po orgazmie. Wsteczny wytrysk może być całkowity lub częściowy, manifestując się suchym orgazmem i niską objętością ejakulatu, a także mętnym moczem po stosunku. Parametry fizykochemiczne moczu, takie jak pH (7,2-8,2) i osmolalność (300-380 mOsm/kg), wpływają na ruchliwość plemników w pęcherzu.

Wsteczny wytrysk – patogeneza, mechanizm

Podstawowy mechanizm fizjologiczny
Patofizjologia wstecznego wytrysku
Przyczyny dysfunkcji zwieracza pęcherza
Mechanizm na poziomie neurochemicznym
Rola pęcherzyka moczowego w wstecznym wytrysku

Diagnostyka wstecznego wytrysku
Wpływ na płodność

Opcje leczenia dla poprawy płodności

Znaczenie dla pacjentów i specjalistów

Kolejne rozdziały

Wsteczny wytrysk – patogeneza, mechanizm

Wsteczny wytrysk (retrograde ejaculation) to zaburzenie polegające na przepływie nasienia w kierunku pęcherza moczowego, zamiast wydalenia go przez cewkę moczową na zewnątrz podczas orgazmu. Zjawisko to ma miejsce, gdy mięśnie okrężne szyi pęcherza moczowego (zwieracz pęcherza) nie funkcjonują prawidłowo, pozostawiając szyję pęcherza otwartą podczas ejakulacji, co pozwala na przepływ wsteczny spermy do pęcherza moczowego¹².

Podstawowy mechanizm fizjologiczny

Ejakulacja składa się z dwóch głównych faz: emisji i ekspulsji. Podczas prawidłowej ejakulacji nasienie jest deponowane w części sterczowej cewki moczowej, a następnie zostaje wyrzucone na zewnątrz przez cewkę moczową³. W normalnych warunkach fizjologicznych, szyja pęcherza zamyka się pod wysokim ciśnieniem podczas ejakulacji, zmuszając nasienie zgromadzone w tylnej cewce moczowej do przepływu w kierunku antegrade przez cewkę moczową i na zewnątrz przez ujście zewnętrzne cewki⁴.

Prawidłowa ejakulacja wymaga złożonej koordynacji i współdziałania między najądrza, nasieniowodami, prostatą, pęcherzykami nasiennymi, szyją pęcherza i gruczołami opuszkowo-cewkowymi. Podczas ejakulacji plemniki są szybko transportowane wzdłuż nasieniowodów do cewki moczowej przez przewody wytryskowe. Stamtąd nasienie przemieszcza się do przodu, częściowo dzięki zamknięciu szyi pęcherza i rytmicznym skurczom mięśni okołocewkowych, koordynowanych przez odruch ośrodkowy⁵.

Zamknięcie szyi pęcherza i emisja nasienia są inicjowane przez układ współczulny z lędźwiowych zwojów współczulnych, a następnie przez nerw podbrzuszny. Wydzielanie prostaty i pęcherzyków nasiennych, a także skurcz mięśni opuszkowo-jamistych, kulszowo-jamistych i mięśni dna miednicy są inicjowane przez układ przywspółczulny S2-4 za pośrednictwem nerwu miednicy⁵.

Patofizjologia wstecznego wytrysku

W przypadku wstecznego wytrysku, mięsień szyi pęcherza nie kurczy się prawidłowo podczas ejakulacji, pozostawiając szyję pęcherza otwartą. W związku z tym, zamiast być wyrzucone na zewnątrz przez cewkę moczową, nasienie płynie wstecznie do pęcherza⁶⁷.

Każdy czynnik, który zakłóca opisany wyżej odruch i hamuje skurcz szyi pęcherza (wewnętrznego zwieracza pęcherza), może prowadzić do wstecznego przepływu nasienia do pęcherza. Można je szeroko sklasyfikować jako przyczyny farmakologiczne, neurogenne, anatomiczne i endokrynologiczne wstecznego wytrysku⁸.

Wytrysk wsteczny jest skutkiem dysfunkcjonalnych mięśni zwieracza pęcherza. Zwykle, podczas stosunku płciowego, mały mięsień zwieracz utrzymuje pęcherz moczowy zamknięty. Jeśli ten mięsień pozostaje otwarty, plemniki mogą płynąć wstecz podczas orgazmu i przedostawać się do pęcherza⁹.

Przyczyny dysfunkcji zwieracza pęcherza

Dysfunkcyjny zwieracz pęcherza moczowego, prowadzący do wstecznego wytrysku, może być wynikiem różnych czynników²:

Uszkodzenia neurologiczne

Dysfunkcja autonomicznego układu nerwowego (dysautonomia) może spowodować nieprawidłowe działanie zwieracza pęcherza. Wsteczny wytrysk jest zarówno powszechny, jak i niedostatecznie rozpoznawany u mężczyzn z cukrzycą, przy czym jedna z badanych serii zgłasza częstość występowania na poziomie 32%¹⁰. Przewlekła niekontrolowana cukrzyca prowadzi do neuropatii autonomicznej, która zakłóca współczulne unerwienie szyi pęcherza, upośledzając jej zdolność do zamykania się podczas ejakulacji¹⁰.

Inne stany neurologiczne mogą również wpływać na nerwy kontrolujące szyję pęcherza, prowadząc do wstecznego wytrysku, w tym stwardnienie rozsiane, choroba Parkinsona, uraz rdzenia kręgowego i udar¹¹.

Interwencje chirurgiczne

Uszkodzenia chirurgiczne nerwów wpływających na funkcję ejakulacji również niosą ze sobą ryzyko wstecznego wytrysku, przy czym najczęstszymi są operacje zaotrzewnowe, chirurgia kolorektalna i chirurgia kręgosłupa¹⁰.

Najbardziej powszechnymi przyczynami są zabieg przezcewkowej resekcji prostaty, eksploracja węzłów chłonnych zaotrzewnowych i neuropatia cukrzycowa¹². Ejakulacja wsteczna może również być powikłaniem operacji prostaty lub pęcherza moczowego, które uszkadzają szyję pęcherza, powodując wsteczny wytrysk¹³.

Większość mężczyzn poddawanych przezcewkowej operacji łagodnego przerostu prostaty (BPH) przy użyciu klasycznych technik doświadcza trwałego wstecznego wytrysku¹⁴. Dokładna resekcja prowadzi do szeroko otwartego ubytku TUR, powodującego niepowodzenie koaptacji szyi pęcherza¹⁵.

Nowsze, minimalnie inwazyjne techniki leczenia BPH mają niższe wskaźniki wstecznego wytrysku, ponieważ zachowują wewnętrzny zwieracz cewki moczowej¹⁴. System Urolift pozwala na operację prostaty w przypadku BPH bez powikłań pooperacyjnych, takich jak wsteczny wytrysk. W przypadku systemu Urolift występuje 0% przypadków wstecznego wytrysku¹⁶.

Czynniki farmakologiczne

Leczenie farmakologiczne różnych stanów może wywołać wsteczny wytrysk u mężczyzn, przy czym najczęstszymi sprawcami są antagoniści receptorów alfa stosowane w leczeniu objawów ze strony dolnych dróg moczowych, inne sympatykolityki stosowane w leczeniu nadciśnienia, leki przeciwdepresyjne i leki przeciwpsychotyczne¹⁰.

Dysfunkcja szyi pęcherza indukowana przez środki farmakologiczne jest częstym czynnikiem przyczyniającym się do wstecznego wytrysku. Może to dotyczyć działania przepisanych leków na BPH, takich jak uroselektywne alfa-blokery, jak silodosin, tamsulosin i alfuzosin¹⁷.

Wsteczny wytrysk jest częstym efektem ubocznym leków, takich jak tamsulosin, stosowanych do relaksacji mięśni dróg moczowych, leczenia stanów takich jak łagodny przerost prostaty².

Tamsulosin (Flomax) i silodosin (Rapaflo) wydają się być alpha-blokerami, które z największym prawdopodobieństwem powodują problemy z ejakulacją. Jeśli problemy z układem moczowym nie są poważne, to najskuteczniejszym podejściem jest zwykle przerwanie stosowania alfa-blokera do czasu osiągnięcia ciąży¹⁸.

Czynniki endokrynologiczne

Czynniki endokrynologiczne, takie jak niedoczynność tarczycy, mogą objawiać się jako mononeuropatia lub polineuropatia czuciowo-ruchowa. Jeśli te stany wpływają na nerwy odpowiedzialne za kontrolę ejakulacji, mogą prowadzić do wstecznego wytrysku¹⁴.

Mechanizm na poziomie neurochemicznym

Na poziomie neurochemicznym, sugeruje się, że odruch ejakulacyjny jest głównie regulowany przez ośrodkowe układy serotoninergiczne i dopaminergiczne, z innymi neuroprzekaźnikami (np. acetylocholina, adrenalina, dopamina, kwas gamma-aminomasłowy [GABA], neuropeptydy, tlenek azotu, oksytocyna i substancja P) odgrywającymi ważne role¹⁹.

Dowody eksperymentalne wskazują, że serotonina (5-HT), poprzez zstępujące drogi mózgowe, wywiera hamującą rolę na ejakulację. W świetle związku między receptorami serotoninergicznymi a ich hamującymi i pobudzającymi efektami, prawdopodobne jest, że zmienione poziomy 5-HT lub zmieniona wrażliwość receptorów 5-HT w ośrodkach modulujących ejakulację ośrodkowego układu nerwowego (OUN) przyczyniają się do patofizjologicznego mechanizmu leżącego u podstaw zaburzeń ejakulacji¹⁹.

W wytrysku wstecznym, dysfunkcja szyi pęcherza indukowana przez leki jest w dużej mierze przypisywana lekom psychotropowym i antagonistom alfa-adrenergicznym. Blokada dopaminergiczna i blokada receptorów 1-adrenergicznych przez leki przeciwpsychotyczne są uważane za kluczowe czynniki odpowiedzialne za wsteczny wytrysk²⁰.

Leki sympatykomimetyczne stymulują uwalnianie noradrenaliny i aktywują receptory alfa- i beta-adrenergiczne, powodując zamknięcie wewnętrznego zwieracza cewki moczowej, przywracając antegrade przepływ nasienia. Najczęstszymi sympatykomimetykami są synefrina, chlorowodorek pseudoefedryny, efedryna, fenylopropanolamina i midodryna⁸.

Leki sympatykomimetyczne są szczególnie przydatne u pacjentów z wolno postępującą chorobą, taką jak neuropatia cukrzycowa, lub u pacjentów bez emisji z powodu przerwania zaotrzewnowego unerwienia współczulnego po operacji²¹.

Rola pęcherzyka moczowego w wstecznym wytrysku

pH i osmolalność próbki moczu mają wpływ na ruchliwość plemników i parametry prędkości. Świeża próbka nasienia ma średnie pH od 7,2 do 8,2 i osmolalność od 300 do 380 mOsm/kg. Jeśli pH i osmolalność są niższe lub wyższe niż normalne wartości referencyjne, prowadzi to do postępującego spadku ruchliwości plemników²².

Wsteczny wytrysk może być częściowy lub całkowity, powodując niską objętość nasienia lub całkowity brak ejakulatu (suchy ejakulat). Wsteczny wytrysk może wynikać z warunków anatomicznych, neurologicznych lub farmakologicznych²².

Uważa się, że dysfunkcja śródbłonka, która prowadzi do nieregularnej sygnalizacji NOS i relaksacji mięśni gładkich w szyi pęcherza/ujściu, może odgrywać główną rolę w rozwoju wstecznego wytrysku i objawów ze strony dolnych dróg moczowych (LUTS)³.

Diagnostyka wstecznego wytrysku

Diagnoza wstecznego wytrysku opiera się na braku plemników w antegrade ejakulacie i obecności plemników w moczu po masturbacji¹². Potwierdzenie diagnozy wymaga znalezienia dużej ilości plemników w próbce moczu pobranej wkrótce po orgazmie²³.

Podstawowym objawem wstecznego wytrysku jest suchy orgazm, czyli ejakulacja niewielkiej ilości lub braku nasienia²⁴. Wsteczny wytrysk może powodować mętny mocz przy następnym oddawaniu moczu po orgazmie²⁵.

Analiza i identyfikacja plemników w moczu po ejakulacji (PEU) wspiera diagnozę wstecznego wytrysku, chociaż nie jest rozstrzygająca. Aby zapobiec fałszywym pozytywom w diagnozie wstecznego wytrysku, opracowano nowe metody diagnostyczne, takie jak aspiracja pęcherza nadłonowego po orgazmie²¹.

Diagnoza częściowego wstecznego wytrysku może być pomocna przy zastosowaniu wskaźnika wstecznego wytrysku (R-ratio), który wyraża całkowitą liczbę plemników odzyskanych w moczu po ejakulacji jako procent całkowitej liczby plemników znalezionych zarówno w nasieniu, jak i w moczu po ejakulacji²⁶.

Wpływ na płodność

Głównym powikłaniem wstecznego wytrysku jest niepłodność, która stanowi problem tylko wtedy, gdy mężczyzna chce zostać ojcem²⁷. Wsteczny wytrysk odpowiada za około 1% wszystkich przypadków niepłodności męskiej w Stanach Zjednoczonych²⁸²⁹.

Badania wykazały, że wsteczny wytrysk może zakłócać problemy z płodnością, ponieważ powoduje niską objętość nasienia i niską lub brak liczby plemników z późniejszą subfertylnością. W jednym badaniu na 207 pacjentów z problemami z niepłodnością, 84 miało wsteczny wytrysk. Ci pacjenci mieli również niższe poziomy hormonu folikulotropowego, hormonu luteinizującego i testosteronu niż osoby bez wstecznego wytrysku³⁰.

Wsteczny wytrysk nie zakłóca zdolności mężczyzny do osiągnięcia erekcji lub orgazmu, ale może powodować niepłodność, ponieważ plemniki nie mogą dotrzeć do macicy kobiety²⁹.

Opcje leczenia dla poprawy płodności

Celem leczenia pacjentów z wstecznym wytryskiem jest przywrócenie antegrade ejakulacji nasienia w celu prób naturalnego poczęcia, a także zbierania plemników do technik wspomaganego rozrodu³¹.

Leki mogą działać na wsteczny wytrysk spowodowany uszkodzeniem nerwów. Ten rodzaj uszkodzenia może być spowodowany cukrzycą, stwardnieniem rozsianym, pewnymi operacjami i innymi stanami i leczeniem³².

Leki stosowane w leczeniu wstecznego wytrysku działają poprzez utrzymywanie mięśnia szyi pęcherza zamkniętego podczas ejakulacji. Leki te obejmują imipraminę (Tofranil), midodrynę, chlorfeniraminę, efedrynę, bronfeniraminę lub fenylefrynę³³³⁴.

Leki generalnie nie pomogą, jeśli wsteczny wytrysk jest spowodowany operacją, która powoduje trwałe zmiany fizyczne w anatomii. Przykłady obejmują operację szyi pęcherza i przezcewkową resekcję prostaty³².

Jeśli leki nie pozwalają na ejakulację nasienia, prawdopodobnie będziesz potrzebował procedur leczenia niepłodności znanych jako wspomagana technologia reprodukcyjna, aby twoja partnerka zaszła w ciążę. W niektórych przypadkach plemniki można odzyskać z pęcherza, przetworzyć w laboratorium i wykorzystać do inseminacji partnerki (inseminacja wewnątrzmaciczna)³².

Bez względu na przyczynę, nasienie często można usunąć z pęcherza i wykorzystać podczas technik wspomaganego rozrodu³⁵. Wiele mężczyzn z wstecznym wytryskiem jest w stanie zajść w ciążę swoim partnerkom po podjęciu leczenia³².

SPERB (Spermatozoa Retrieval from Bladder) to prosta, a zarazem nowatorska i nieinwazyjna technika. Pobieranie plemników z pęcherza odbywa się z łatwością, wystarczy poinstruować pacjenta o wykonaniu prostych czynności. Opróżnienie pęcherza i oddanie moczu po stosunku/masturbacji do podłoża działa jak bufor i zmniejsza kwaśne pH resztkowego moczu, utrzymując ruchliwość plemników³⁶.

Znaczenie dla pacjentów i specjalistów

Wsteczny wytrysk nie zawsze wymaga leczenia, chyba że zakłóca płodność. W takich przypadkach leczenie zależy od podstawowej przyczyny³². Wsteczny wytrysk nie jest ani niebezpieczny, ani bolesny i nie zawsze wymaga leczenia³⁷.

Wsteczny wytrysk spowodowany operacją lub cukrzycą często nie może być skorygowany. To najczęściej nie jest problem, chyba że próbujesz począć dziecko. Niektórym mężczyznom nie podoba się to uczucie i szukają leczenia. W przeciwnym razie nie ma potrzeby leczenia³⁸.

Wsteczny wytrysk związany z lekami przeciwpsychotycznymi jest ważnym, niedostatecznie rozpoznanym efektem ubocznym, który może mieć wpływ na stosowanie się do leczenia. Generalnie strategie radzenia sobie z wstecznym wytryskiem wywołanym przez leki przeciwpsychotyczne są następujące: zmniejszenie dawki leku wywołującego, przerwy w podawaniu leku, w których lek wywołujący zostanie przerwany na 2 do 3 dni przed przewidywaną aktywnością seksualną, leczenie uzupełniające innymi lekami i przejście na inny lek przeciwpsychotyczny³⁹.

Jeśli wsteczny wytrysk jest spowodowany lekiem, normalna ejakulacja często powraca po przerwaniu stosowania leku³⁵. Proste terapie mają dużą szansę na zmniejszenie wstecznego wytrysku wystarczająco, aby umożliwić poczęcie⁴⁰.

Stan może spowodować niepłodność. Jednakże nasienie często można usunąć z pęcherza i wykorzystać podczas technik wspomaganego rozrodu³⁵. W przypadkach, gdy wsteczny wytrysk nie reaguje na leczenie medyczne, procedura modyfikowana Hotchkissa była wykorzystywana do odzyskiwania plemników, a odzyskane plemniki były zamrażane⁴¹.

Wsteczny wytrysk nie jest zawsze odwracalny. Jednak niepłodność, którą może powodować, jest uleczalna³⁷. Dobra wiadomość jest taka, że wsteczny wytrysk spowodowany przez silodosin jest zwykle odwracalny po przerwaniu stosowania leku⁴².

Podsumowując, wsteczny wytrysk jest zaburzeniem ejakulacji, które może mieć wpływ na płodność, ale nie ma wpływu na ogólne zdrowie i samopoczucie pacjenta. Leczenie jest dostępne dla tych, którzy chcą poprawić płodność lub doświadczają dyskomfortu związanego z objawami. Ważne jest, aby pacjenci z objawami wstecznego wytrysku skonsultowali się z pracownikiem służby zdrowia w celu właściwej diagnozy i opcji leczenia.

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Materiały źródłowe

#1 Retrograde Ejaculation: Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/21870-retrograde-ejaculation
Retrograde ejaculation is caused by a problem with your circular muscle (called the bladder sphincter) that closes to let semen out and keeps urine in your body. Because your sphincter doesnt work correctly, your bladder neck stays open instead of closing allowing the ejaculate to take the path of least resistance into the bladder. […] Retrograde ejaculation is a somewhat common occurrence due to many causes, including medication use, surgery and medical conditions. While healthcare providers dont see it as being painful or harmful, it can be a problem for people who want to conceive. There are ways to treat retrograde ejaculation. Speak to your healthcare provider about any of your concerns.
#2 Retrograde ejaculation – Wikipedia
https://en.wikipedia.org/wiki/Retrograde_ejaculation
Retrograde ejaculation occurs when semen which would be ejaculated via the urethra is redirected to the urinary bladder. […] When the bladder sphincter does not function properly, retrograde ejaculation may occur. […] In retrograde ejaculation, these bladder neck muscles are either very weak or the nerves controlling the muscles have been damaged. […] A malfunctioning bladder sphincter, leading to retrograde ejaculation, may be a result either of: Autonomic nervous system dysfunction. (Dysautonomia) […] It can also be caused by a retroperitoneal lymph node dissection for testicular cancer if nerve pathways to the bladder sphincter are damaged, with the resulting retrograde ejaculation being either temporary or permanent. […] Retrograde ejaculation is a common side effect of medications, such as tamsulosin, that are used to relax the muscles of the urinary tract, treating conditions such as benign prostatic hyperplasia.
#3 Ejaculatory dysfunction in the treatment of lower urinary tract symptoms – DeLay – Translational Andrology and Urology
https://tau.amegroups.org/article/view/11041/html
Ejaculation is a complex process, composed of two main phases, emission (ejaculate is deposited into the prostatic urethra from testes and accessory sex glands) and expulsion (semen is forcefully expelled from the urethral meatus). […] Retrograde ejaculation is the result of a problem during the expulsion phase of ejaculation. Emission of semen into the prostatic urethra remains intact. However, during expulsion, semen is sent into the urinary bladder, rather than being sent antegrade into the penile urethra. The retrograde flow of ejaculate into the bladder is permitted by a pathologically open internal vesical sphincter, or bladder neck. […] Endothelial dysfunction that leads to irregular NOS signaling and smooth muscle relaxation at the bladder neck/outlet could play a major role in the development of retrograde ejaculation and LUTS.
#4 Retrograde ejaculation â GPnotebook
https://gpnotebook.com/pages/urology/retrograde-ejaculation
Retrograde ejaculation (RE) occurs when the semen passes into the bladder rather than along the urethra. […] RE is a common type of ejaculatory dysfunction, but accounts for only 0.3%-2% of male infertility. […] this condition is marked by substantial retrograde propulsion of seminal fluid into the bladder. […] in the normal physiological state, the bladder neck closes with high pressure during ejaculation, forcing semen deposited into the posterior urethra to flow antegrade through the urethra and out the urethral meatus. […] with impaired or absent bladder neck closure, however, semen in the proximal urethra may be propelled along the path of least resistance into the bladder. […] underlying causes of RE may be divided into pharmacological, neurogenic and anatomic causes. […] pharmacologically-induced RE, as previously discussed, is largely attributable to psychotropic medications and alpha-adrenergic blockers.
#5 EAU Guidelines on Sexual and Reproductive Health – Uroweb
https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/disorders-of-ejaculation
Retrograde ejaculation is the total, or sometimes partial, absence of antegrade ejaculation, due to semen passing backwards through the bladder neck into the bladder. Patients may experience a normal or decreased orgasmic sensation. The causes of retrograde ejaculation can be divided into neurogenic, pharmacological, urethral, or bladder neck incompetence. […] The process of ejaculation requires complex co-ordination and interplay between the epididymis, vas deferens, prostate, seminal vesicles, bladder neck and bulbourethral glands. Upon ejaculation, sperm are rapidly conveyed along the vas deferens and into the urethra via the ejaculatory ducts. From there, the semen progresses in an antegrade fashion, partly maintained by coaptation of the bladder neck and rhythmic contractions of the periurethral muscles, co-ordinated by a centrally mediated reflex. Closure of the bladder neck and seminal emission is initiated via the sympathetic nervous system from the lumbar sympathetic ganglia and subsequently hypogastric nerve. Prostatic and seminal vesicle secretion, as well as contraction of the bulbo-cavernosal, ischio-cavernosal and pelvic floor muscles are initiated by the S2-4 parasympathetic nervous system via the pelvic nerve.
#6
https://www.amerikanhastanesi.org/mayo-clinic-care-network/mayo-clinic-health-information-library/diseases-conditions/retrograde-ejaculation
Retrograde ejaculation occurs when semen enters the bladder instead of emerging through the penis during orgasm. Although you still reach sexual climax, you might ejaculate very little or no semen. This is sometimes called a dry orgasm. […] Retrograde ejaculation isn’t harmful, but it can cause male infertility. Treatment for retrograde ejaculation is generally only needed to restore fertility. […] During a male orgasm, a tube called the vas deferens transports sperm to the prostate, where they mix with other fluids to produce liquid semen (ejaculate). The muscle at the opening of the bladder (bladder neck muscle) tightens to prevent ejaculate from entering the bladder as it passes from the prostate into the tube inside the penis (urethra). This is the same muscle that holds urine in your bladder until you urinate.
#7
https://www.amerikanhastanesi.org/mayo-clinic-care-network/mayo-clinic-health-information-library/diseases-conditions/retrograde-ejaculation
With retrograde ejaculation, the bladder neck muscle doesn’t tighten properly. As a result, sperm can enter the bladder instead of being ejected out of your body through the penis. […] Several conditions can cause problems with the muscle that closes the bladder during ejaculation. These include: Surgery, such as bladder neck surgery, retroperitoneal lymph node dissection surgery for testicular cancer or prostate surgery; Side effect of certain medications used to treat high blood pressure, prostate enlargement and depression; Nerve damage caused by a medical condition, such as diabetes, multiple sclerosis, Parkinson’s disease or a spinal cord injury. […] A dry orgasm is the primary sign of retrograde ejaculation. But dry orgasm the ejaculation of little or no semen can also be caused by other conditions, including: Surgical removal of the prostate (prostatectomy); Surgical removal of the bladder (cystectomy); Radiation therapy to treat cancer in the pelvic area.
#8 EAU Guidelines on Sexual and Reproductive Health – Uroweb
https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/disorders-of-ejaculation
Any factor that disrupts this reflex and inhibits contraction of the bladder neck (internal vesical sphincter) may lead to retrograde passage of semen into the bladder. These can be broadly categorised as pharmacological, neurogenic, anatomic and endocrinal causes of retrograde ejaculation. […] Sympathomimetics stimulate the release of noradrenaline and activate – and -adrenergic receptors, resulting in closure of the internal urethral sphincter, restoring the antegrade flow of semen. The most common sympathomimetics are synephrine, pseudoephedrine hydrochloride, ephedrine, phenylpropanolamine and midodrine. Unfortunately, as time progresses, their effect diminishes. Many studies published about the efficacy of sympathomimetics in the treatment of retrograde ejaculation suffer from small sample size, with some represented by case reports.
#9 Retrograde Ejaculation: Causes, Symptoms, and Treatments
https://www.webmd.com/men/what-is-retrograde-ejaculation
Retrograde ejaculation is caused by a problem with your bladder muscle. Ordinarily, when you have sex, a small sphincter muscle holds your bladder closed. If this muscle stays open, sperm can flow backward during orgasm and go into the bladder. […] Conditions that may cause it include nerve damage. […] The treatment for retrograde ejaculation depends on the cause. If you have nerve damage, your doctor may recommend medication. […] Common drugs that may help retrograde ejaculation include Imipramine. This is an antidepressant that may also help with bed-wetting in children. […] Midodrine. This is a drug to help with low blood pressure. Doctors also prescribe it to help with issues with semen transport in the body. […] Certain antihistamines. Chlorpheniramine and brompheniramine can help retrograde ejaculation, though they are often used for allergies. […] Certain decongestants. Phenylephrine and pseudoephedrine can also help retrograde ejaculation.
#10 Ejaculatory physiology and pathophysiology: assessment and treatment in male infertility
https://pmc.ncbi.nlm.nih.gov/articles/PMC4708301/
Retrograde ejaculation is the flow of semen into the bladder due to an incompletely closed bladder neck. […] A variety of mechanical, neurologic, and pharmacologic etiologies are responsible for retrograde ejaculation. […] Surgical injury to the nerves influencing ejaculatory function also carry the risk of retrograde ejaculation with the most common being retroperitoneal surgeries, colorectal surgery, and spine surgery. […] Retrograde ejaculation is both common and under-recognized in diabetic men, with one series reporting a prevalence of 32%. […] Chronic uncontrolled diabetes results in an autonomic neuropathy that disrupts the sympathetic output to the bladder neck, impairing its ability to close during ejaculation. […] Pharmacologic treatment for a variety of conditions can induce retrograde ejaculation in men, with the most common offenders being alpha-receptor antagonists for lower urinary tract symptoms, other sympatholytics for hypertension, antidepressants, and antipsychotics.
#11 Retrograde ejaculation: Causes, symptoms & treatment
https://healthymale.org.au/mens-health/retrograde-ejaculation
Retrograde ejaculation is when semen travels backwards into the bladder when you have an orgasm. […] Retrograde ejaculation is when semen travels backwards and enters the bladder when you have an orgasm, instead of going forward, out through the penis. […] Normally when you orgasm and ejaculate, the muscle at the base of the bladder contracts so semen in the urethra travels out through the penis. If this does not occur, or if the muscle does not close off the bladder outlet completely, semen can flow backwards into the bladder. […] This can be caused by a number of things, including: Some medicines, including some types of antidepressants and drugs used to treat urinary symptoms associated with benign prostatic hyperplasia (BPH) […] Neurological conditions such as multiple sclerosis, Parkinsons disease and stroke […] Surgical procedures that affect the nerves involved in orgasm and ejaculation […] Nerve damage due to diabetes […] Surgery to treat BPH. […] In some cases, there are anatomical causes of retrograde ejaculation (for example, developmental abnormalities).
#12 Retrograde ejaculation – PubMed
https://pubmed.ncbi.nlm.nih.gov/2056022/
Failure of the normal ejaculatory mechanism may lead to retrograde ejaculation. This occurs most commonly as a result of transurethral prostatectomy, retroperitoneal lymph-node dissection and diabetic neuropathy. […] The diagnosis is based on the absence of sperm in the antegrade ejaculate and the presence of sperm in the post-masturbatory urine. […] If pharmacologic attempts to restore antegrade ejaculation fail, sperm recovery from the urine and intrauterine insemination are usually indicated. Surgical alternatives are discussed.
#13 Retrograde ejaculation Information | Mount Sinai – New York
https://www.mountsinai.org/health-library/diseases-conditions/retrograde-ejaculation
Retrograde ejaculation occurs when semen goes backward into the bladder. Normally, it moves forward and out of the penis through the urethra during ejaculation. […] Retrograde ejaculation is uncommon. It most often occurs when the opening of the bladder (bladder neck) does not close. This causes semen to go backward into the bladder rather than forward out of the penis. […] Retrograde ejaculation that is caused by diabetes or surgery may be treated with medicines such as pseudoephedrine or imipramine. […] If the problem is caused by a medicine, normal ejaculation will often come back after the medicine is stopped. Retrograde ejaculation caused by surgery or diabetes often can’t be corrected. […] The condition may cause infertility. However, semen can often be removed from the bladder and used during assistive reproductive techniques.
#14 Recent Advances in the Diagnosis and Management of Retrograde Ejaculation: A Narrative Review
https://www.mdpi.com/2075-4418/15/6/726
The majority of men undergoing transurethral surgery for benign prostatic hyperplasia (BPH) using classical techniques experience permanent RE. […] To date, only one study has specifically examined the anatomical course and relationships of the ejaculatory ducts, using six cadaveric subjects over 50 years old. […] Because they keep the internal urethral sphincter intact, the newer minimally invasive techniques for BPH management have lower rates of RE. […] Nerve damage linked to uncontrolled diabetes mellitus, multiple sclerosis, retroperitoneal lymph node dissection without nerve sparing, or spinal cord injury can result in functional impairment in the closure of the bladder neck. […] Endocrine factors, such as hypothyroidism, can manifest as mononeuropathy or sensorimotor polyneuropathy. If these conditions affect the nerves responsible for controlling ejaculation, they may result in retrograde ejaculation.
#15 Ejaculatory Dysfunction: Retrograde Ejaculation | Abdominal Key
https://abdominalkey.com/ejaculatory-dysfunction-retrograde-ejaculation/
Theoretically speaking, retrograde ejaculation in patients with multiple sclerosis may be caused by the same mechanism as in diabetic patients, though the authors are not aware of any studies specifically demonstrating this mechanism. […] Classically, surgical treatment for benign prostatic hypertrophy (BPH) has been long associated with retrograde ejaculation. […] A thorough resection leads to a wide-mouthed TUR defect, causing failure of bladder neck coaptation. […] A recent review by Marra et al. noted that the overall rate of retrograde ejaculation was 66.1%. […] However, it must be noted that these techniques must be used on appropriately selected patients with smaller prostates. […] Retroperitoneal lymph node dissection disrupts the pre-aortic postganglionic sympathetic fibers, which can interfere with ejaculation (but not erection).
#16 Retrograde ejaculation: what is it and why does it occur?
https://www.operarme.com/blog/retrograde-ejaculation-what-is-it-and-why-does-it-occur/
Prostate surgery with the Urolift System is a surgery to free the urethral duct of Benign Hyperplasia. It is a minimally invasive technique in which prostate problems are solved, preserving full sexual function. […] Urolift System makes it possible to operate on the prostate for BPH without postoperative consequences such as retrograde ejaculation. […] With the Urolift System there are 0% cases of retrograde ejaculation.
#17 Recent Advances in the Diagnosis and Management of Retrograde Ejaculation: A Narrative Review
https://www.mdpi.com/2075-4418/15/6/726
Retrograde ejaculation (RE) is a condition where the forward expulsion of seminal fluid is impaired, leading to infertility and psychological distress in affected individuals. […] RE may result in the partial or complete absence of the ejaculate. Causes of RE include anatomical, neurological, pharmacological, and endocrine factors, with common triggers such as diabetes, spinal cord injury, and prostate surgery. […] From a physiological perspective, RE results from a combination of factors, including defective bladder function and impaired sphincter control. These issues can be congenital or acquired, primary or secondary. […] Bladder neck dysfunction induced by pharmacological agents is a prevalent factor contributing to RE. This may involve the effect of prescribed medications for BPH, such as uroselective alpha-blockers like silodosin, tamsulosin, and alfuzosin.
#18 Ejaculatory Dysfunction and Male Infertility — Male Infertility Guide
https://www.maleinfertilityguide.com/ejaculatory-dysfunction
Tamsulosin (Flomax) and silodosin (Rapaflo) seem to be the alpha-blockers that are most likely to cause ejaculatory problems. If the urinary problems are not severe, then stopping the alpha-blocker until pregnancy is achieved is usually the most effective approach. […] Alpha agonists work by increasing the strength of bladder neck closure during ejaculation. In men without bladder neck scarring (for example, those who have not had prior prostate surgery), the success rate in reversing retrograde ejaculation is about 20-30 percent.
#19 Delayed Ejaculation: Background, Etiology, Pathophysiology
https://emedicine.medscape.com/article/2184956-overview
It has been suggested that the ejaculatory reflex is primarily regulated by the central serotonergic and dopaminergic systems, with other neurotransmitters (eg, acetylcholine, adrenaline, dopamine, gamma-aminobutyric acid [GABA], neuropeptides, nitric oxide, oxytocin, and substance P) playing important roles. […] Experimental evidence indicates that serotonin (5-HT), throughout brain descending pathways, exerts an inhibitory role on ejaculation. […] In view of the relation between the serotonergic receptors and their inhibitory and excitatory effects, it is likely that altered levels of 5-HT or altered 5-HT receptor sensitivity in the ejaculatory modulating centers of the central nervous system (CNS) contribute to the pathophysiologic mechanism behind ejaculatory disorders. Thus, 5-HT might suppress ejaculation by interrupting the action of oxytocin, which normally accompanies sexual behavior.
#20 Retrograde Ejaculation With Second-Generation Antipsychotics in Schizophrenia: A Case Series and Literature Review
https://www.psychiatrist.com/pcc/retrograde-ejaculation-second-generation-antipsychotics-schizophrenia/
Sexual adverse effects related to antipsychotic medications are not uncommon in patients with schizophrenia. However, retrograde ejaculation (RE) is quite often underreported by patients, which could have an influence on treatment adherence, fertility, and quality of life. Hence, effective identification and appropriate management of RE is essential. […] The RE associated with antipsychotics is an important, underrecognized adverse effect that may have bearing on treatment adherence. Our report highlights the features of RE associated with SGAs such as onset, dose-dependent nature, and management. […] Ejaculation is a complex process predominantly comprising 2 phases, emission and expulsion, which is subserved by the sympathetic nervous system. During the expulsion phase, failure of closure of the bladder neck results in varying degrees of retrograde ejaculation characterized by the absence of seminal emission, reduced ejaculate volume, and reduced ejaculation force. Dopaminergic blockade and 1-adrenoreceptor blockade with antipsychotics are thought to be the key factors responsible for retrograde ejaculation.
#21 Sperm recovery from urine in men with retrograde ejaculation
https://www.degruyterbrill.com/document/doi/10.1515/almed-2024-0109/html?lang=en&srsltid=AfmBOorMbzfbluMSBTuI3PfzUUkPLN8kQmiggmYV0OETO0cbp3JmW9V8
The presence of aspermia or detection of hypospermia associated with oligozoospermia should raise suspicion of RE. […] The analysis and identification of sperm in PEU support RE diagnosis, although they are not conclusive. […] Although diagnosis is established upon confirmation of the presence of sperm in PEU, it has been shown that this also occurs in 60-70% of MPP, which casts doubt on the validity of this criterion. […] To prevent false positives in the diagnosis of RE, new diagnostic methods have been developed, such as suprapubic bladder aspiration after orgasm. […] The first-line treatment for RE is pharmacological. This treatment is intended to increase the sympathetic tone both of the IUS and the vas deferens to prevent semen from retrogradely flowing into the bladder. […] Sympathomimetic drugs are especially useful in patients with slow-progressive disease, such as diabetic neuropathy, or in patients without emission due to an interruption of retroperitoneal sympathetic innervations after surgery.
#22 :: WJMH :: World Journal of Men’s Health
https://wjmh.org/DOIx.php?id=10.5534/wjmh.210069
Various disorders can result in bladder neck dysfunction and RE. Anatomical disruption following prostatectomy, cystectomy, traumatic bladder injury or radiation therapy to treat cancer in the pelvic area, are common causes of RE. Neuropathy resulting from nerve damage secondary to uncontrolled diabetes, multiple sclerosis, non-nerve sparing retroperitoneal lymph node dissection or spinal cord injury could lead to a functional bladder neck closure incompetency. […] Unlike other ejaculatory disorders, which exhibit a mixture of both psychological and organic origins, causes of RE are mainly organic and include pharmacological, neurogenic, and anatomical abnormalities. […] The pH and osmolality of the urine specimen have effects on sperm motility and velocity parameters. The fresh semen sample has an average pH of 7.2 to 8.2 and osmolality of 300 to 380 mOsm/kg. If the pH and osmolality are lower or higher than the normal reference values, it leads to progressive decline in sperm motility.
#22 :: WJMH :: World Journal of Men’s Health
https://wjmh.org/DOIx.php?id=10.5534/wjmh.210069
Retrograde ejaculation (RE) is a condition defined as the backward flow of the semen during ejaculation, and when present can result in male infertility. RE may be partial or complete, resulting in either low seminal volume or complete absence of the ejaculate (dry ejaculate). RE can result from anatomic, neurological or pharmacological conditions. […] Retrograde ejaculation (RE) is an ejaculatory disorder that results in substantial redirection of semen from the posterior urethra into the bladder. It occurs secondary to suboptimal bladder neck closure, due to sympathetic neuropathic dysfunction or to organic lesions. […] In RE, the bladder neck does not contract adequately during ejaculation, due to either an anatomical or neurogenic functional defect of the internal sphincter. This permits the expelled semen to follow the passage with lower resistance and therefore pass into the urinary bladder, in a retrograde fashion.
#23 Retrograde Ejaculation – Men’s Health Issues – Merck Manual Consumer Version
https://www.merckmanuals.com/en-ca/home/men-s-health-issues/sexual-function-and-dysfunction-in-men/retrograde-ejaculation
Retrograde ejaculation is a condition in which semen is ejaculated backward into the bladder rather than out through the penis. […] In retrograde ejaculation, the part of the bladder that normally closes during ejaculation (the bladder neck) remains open, causing the semen to travel backward into the bladder. One of the most common causes is prostate surgery for noncancerous prostate enlargement. Other common causes of retrograde ejaculation include diabetes, spinal cord injuries, certain medications, and some surgical operations (including major abdominal or pelvic surgery). […] A doctor makes the diagnosis of retrograde ejaculation by finding a large amount of sperm in a urine sample taken shortly after orgasm.
#24 Retrograde ejaculation // Middlesex Health
https://middlesexhealth.org/learning-center/diseases-and-conditions/retrograde-ejaculation
Retrograde ejaculation occurs when semen enters the bladder instead of emerging through the penis during orgasm. […] Retrograde ejaculation isn’t harmful, but it can cause male infertility. […] With retrograde ejaculation, the bladder neck muscle doesn’t tighten properly. As a result, sperm can enter the bladder instead of being ejected out of your body through the penis. […] Several conditions can cause problems with the muscle that closes the bladder during ejaculation. […] A dry orgasm is the primary sign of retrograde ejaculation. […] Retrograde ejaculation typically doesn’t require treatment unless it interferes with fertility. […] If you have retrograde ejaculation, you’ll likely need treatment to get your female partner pregnant. […] Many men with retrograde ejaculation are able to get their partners pregnant once they seek treatment.
#25 Retrograde Ejaculation: Symptoms, Causes & Treatment | hims
https://www.forhims.co.uk/blog/retrograde-ejaculation-causes-treatments
Retrograde ejaculation can cause cloudy urine the next time you pee after an orgasm. […] Retrograde ejaculation isnât painful and usually doesnât feel different from any other orgasm. […] Most often, it happens because of medication side effects, surgical complications, or medical conditions or anatomical abnormalities. […] Some surgical procedures can damage the muscles and nerves around the bladder and lead to retrograde ejaculation. […] Certain medical conditions can lead to dysfunction in the muscles or nerves around the bladder and cause retrograde ejaculation.
#26 Diagnosis of Partial Retrograde Ejaculation in Non-Azoospermic Infertile Men with Low Semen Volume | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0168742
In non-azoospermic patients with low semen volume (LSV), looking for partial retrograde ejaculation (PRE) by searching sperm in the postejaculatory urine (PEU) is required. […] Retrograde ejaculation corresponds to the failure of the bladder neck to close resulting in reflux of semen into the bladder. This results in a low-volume ejaculate and a low or null sperm count. […] A search for spermatozoa in urine after ejaculation (postejaculatory urine; PEU) to determine presence of PRE is also recommended in infertile patients presenting with low semen volume. […] The use of a retro-ejaculatory index (R-ratio), which expresses the total number of sperm recovered in PEU as a percentage of the total number of sperm found in both semen and PEU, has been suggested to define PRE. […] Based on male partners of infertile couples selected to be devoid of any known risk factors for retrograde ejaculation or low semen volume, the main objective of the present study was to define a threshold for the R-ratio as indicative of the presence of an abnormal number of sperm in PEU, i.e. PRE, in non-azoospermic patients presenting with low semen volume.
#27 Retrograde Ejaculation: Treatment, Symptoms, and More
https://www.healthline.com/health/mens-health/retrograde-ejaculation
In retrograde ejaculation, this muscle fails to contract. Because it stays relaxed, the ejaculate ends up in your bladder. […] Retrograde ejaculation is a potential side effect of some medications, including those prescribed to treat enlarged prostate, high blood pressure, or depression. […] The most common causes of retrograde ejaculation are prostate surgery and bladder surgery. […] Retrograde ejaculation doesn’t necessarily require treatment. […] A variety of medications can help keep the bladder neck muscle constricted during ejaculation. […] If you have severe nerve or muscle damage due to surgery, medications are generally not effective. […] The major complication is infertility, and that’s only a problem if you want to father a child.
#28 Retrograde Ejaculation – Harvard Health
https://www.health.harvard.edu/a_to_z/retrograde-ejaculation-a-to-z
Ejaculation is the ejection of semen out of the urethra (passageway inside the penis) when a man has an orgasm. Retrograde ejaculation is when the semen travels backwards into the bladder. […] In retrograde ejaculation, the muscle that shuts the bladder does not function normally. This allows all or part of the semen to travel backward (retrograde) into the bladder at the time of ejaculation. […] Retrograde ejaculation has several possible causes, including: Damage from surgery to the muscles of the bladder, or to the nerves that control these muscles. […] Retrograde ejaculation does not interfere with a man’s ability to have an erection or to achieve orgasm, but it can cause infertility because the sperm cannot reach the woman’s uterus. Retrograde ejaculation is responsible for about 1% of all cases of male infertility in the United States.
#29 Retrograde Ejaculation – Harvard Health
http://www.health.harvard.eduwww.health.harvard.edu/a_to_z/retrograde-ejaculation-a-to-z
Ejaculation is the ejection of semen out of the urethra (passageway inside the penis) when a man has an orgasm. Retrograde ejaculation is when the semen travels backwards into the bladder. […] In retrograde ejaculation, the muscle that shuts the bladder does not function normally. This allows all or part of the semen to travel backward (retrograde) into the bladder at the time of ejaculation. […] Retrograde ejaculation has several possible causes, including: Damage from surgery to the muscles of the bladder, or to the nerves that control these muscles. […] Retrograde ejaculation does not interfere with a man’s ability to have an erection or to achieve orgasm, but it can cause infertility because the sperm cannot reach the woman’s uterus. Retrograde ejaculation is responsible for about 1% of all cases of male infertility in the United States.
#30 Retrograde ejaculation: what causes „dry orgasm”: what causes it and how it affects fertility – Give Legacy
https://www.givelegacy.com/resources/retrograde-ejaculation/
Certain medications used to treat prostate enlargement, high blood pressure, and depression may cause retrograde ejaculation. […] According to a 2016 study, retrograde ejaculation may also be the result of damage to the nerves that control the bladder neck muscle. This nerve damage may be caused by a number of conditions such as diabetes, multiple sclerosis, or spinal cord injuries. […] Research has shown that retrograde ejaculation can interfere with fertility problems, as it causes low semen volume and a low or absent sperm count with subsequent subfertility. In one study of 207 patients with infertility issues, 84 had retrograde ejaculation. These patients also had lower levels of follicle-stimulating hormone, luteinizing hormone, and testosterone than those without retrograde ejaculation.
#31 Ejaculatory physiology and pathophysiology: assessment and treatment in male infertility
https://pmc.ncbi.nlm.nih.gov/articles/PMC4708301/
The goal for treatment of patients with RE is to restore antegrade ejaculation of semen for attempts at natural conception as well as collection of sperm for assisted reproductive techniques. […] In cases of neuropathy-induced, iatrogenic, or idiopathic retrograde ejaculation, sympathomimetic drugs have had the most, albeit modest, success. […] The mechanism of sympathomimetic action is to improve bladder neck contraction during the expulsive phase of ejaculation. […] If the goal of treatment is to harvest sperm for use with assisted reproductive techniques, then sperm can be used either from the converted antegrade ejaculate or from harvesting of post-orgasm bladder samples.
#32 Retrograde ejaculation – Diagnosis & treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/retrograde-ejaculation/diagnosis-treatment/drc-20354896
Retrograde ejaculation typically doesn’t require treatment unless it interferes with fertility. In such cases, treatment depends on the underlying cause. […] Medications might work for retrograde ejaculation caused by nerve damage. This type of damage can be caused by diabetes, multiple sclerosis, certain surgeries, and other conditions and treatments. […] Drugs generally won’t help if retrograde ejaculation is due to surgery that causes permanent physical changes of your anatomy. Examples include bladder neck surgery and transurethral resection of the prostate. […] If medication doesn’t allow you to ejaculate semen, you will likely need infertility procedures known as assisted reproductive technology to get your partner pregnant. In some cases, sperm can be recovered from the bladder, processed in the laboratory and used to inseminate your partner (intrauterine insemination). […] Sometimes, more-advanced assisted reproductive techniques are needed. Many men with retrograde ejaculation are able to get their partners pregnant once they seek treatment.
#33 Retrograde Ejaculation: Symptoms, Causes & Treatment – Tua SaÃºde
https://www.tuasaude.com/en/retrograde-ejaculation/
Retrograde ejaculation is a condition that refers to sperm that travels into the bladder instead of flowing out through the urethra. […] However, when this sphincter is not working correctly, it can remain open during orgasm, which can cause sperm to enter the bladder. Some causes for this abnormality can include: […] Depending on the cause, treatment for retrograde ejaculation can vary in complexity. […] The most commonly used medications include imipramine, midodrine, chlorpheniramine, bronpheniramine, ephedrine, pseudoephedrine, or phenylephrine. These medication can regulate the functioning of the nerves in the pelvic area, which can become compromised with conditions like diabetes or multiple sclerosis. […] These medications may not have the expected effect on injuries caused by surgery, as treatment effect and condition severity will depend on the level of the injury.
#34 Retrograde Ejaculation – Lazare Urology
https://drjonlazare.com/retrograde-ejaculation/
Retrograde ejaculation or RE results in a dry ejaculate. In other words, the man notices that during orgasm, little or no fluid comes out of his penis. RE occurs because fluid goes backwards into the bladder rather forward and out the tip of the penis. […] During normal orgasm, the ejaculatory fluid enters the urethra in the vicinity of the prostate. The muscle at the opening of the bladder tightens to prevent liquid semen from entering the bladder. This muscle ensures that during orgasm, the semen moves forward and out the tip of the penis. Contraction of this muscle prevents the semen from going backwards into the bladder. […] There are several conditions that can interfere with the function of this muscle at the bladder neck. […] Medications work by tightening the muscles of the bladder neck. This helps to prevent RE. The medications that are used most often to treat retrograde ejaculation include imipramine -Tofranil, ephedrine, pseudoephedrine, and phenylephrine. […] Retrograde ejaculation is not completely preventable. However, controlling medical conditions that can lead to nerve damage may help to prevent the condition.
#35 Retrograde ejaculation | Lima Memorial Health System
https://www.limamemorial.org/health-library/HIE%20Multimedia-TextOnly/1/001282
Retrograde ejaculation occurs when semen goes backward into the bladder. Normally, it moves forward and out of the penis through the urethra during ejaculation. […] Retrograde ejaculation is uncommon. It most often occurs when the opening of the bladder (bladder neck) does not close. This causes semen to go backward into the bladder rather than forward out of the penis. […] Retrograde ejaculation may be caused by: Diabetes, Some medicines, including drugs used to treat high blood pressure and some mood-altering drugs, Medicines or surgery to treat prostate or urethra problems. […] Retrograde ejaculation that is caused by diabetes or surgery may be treated with drugs such as pseudoephedrine or imipramine. […] If the problem is caused by a medicine, normal ejaculation will often come back after the drug is stopped. Retrograde ejaculation caused by surgery or diabetes often can’t be corrected. […] The condition may cause infertility. However, semen can often be removed from the bladder and used during assistive reproductive techniques.
#36 A simple non-invasive method of spermatozoa retrieval from the bladder (SPERB) in patients with retrograde ejaculation – Fertility Science and Research
https://fertilityscienceresearch.org/a-simple-non-invasive-method-of-spermatozoa-retrieval-from-the-bladder-sperb-in-patients-with-retrograde-ejaculation/
Retrograde ejaculation (RGE) is the commonest cause of Aspermia. It is a type of ejaculatory dysfunction where semen is pushed retrograde into the urinary bladder instead of the normal antegrade flow into the urethra during ejaculation. The absence of antegrade ejaculation causes male infertility. The events of sexual function like libido, arousal, and erection are normal in patients with retrograde ejaculation. The process of emission takes place but due to inadequate closure of bladder neck, semen flows into the urinary bladder. The semen deposited into the bladder is exposed directly to the acidic urine, which makes the spermatozoa either immotile or non-vital. In order to treat infertility, it is essential to isolate the spermatozoa from urine and retain spermatozoa motility and viability. The final diagnosis of retrograde ejaculation is made by identifying spermatozoa in the post coital/masturbatory urine. In these patients with normal spermatogenesis, plenty of immotile spermatozoa can be seen. As there is mixture of semen with urine in the bladder, the acidic pH of urine renders the spermatozoa immotile/non-viable. Isolation of motile spermatozoa is essential in these patients to treat infertility. Many methods have been employed for isolation of motile spermatozoa from patients diagnosed with retrograde ejaculation. SPERB, is a simple yet novel technique and is non-invasive. Spermatozoa retrieval from the bladder is done at ease just by instructing the patients to follow simple instructions. Emptying the bladder and voiding the post coital/masturbatory urine into the media acts as a buffer and reduces the acidic pH of residual urine thereby maintaining spermatozoa motility.
#37 Retrograde ejaculation: Treatment and causes
https://www.medicalnewstoday.com/articles/320332
Normal ejaculation forces semensometimes called ejaculatethrough the mans urethra and out of the penis. […] When the bladder sphincter does not work correctly, the bladder may not close completely, which can cause ejaculate to travel into the bladder rather than coming out of the penis. […] Retrograde ejaculation is a symptom, not a diagnosis. […] Retrograde ejaculation may be caused by: […] Removal of part of the prostate through surgery is one of the most common causes of retrograde ejaculation. […] About 10 to 15 percent of people who undergo this surgery can expect to experience retrograde ejaculation because surgery may damage the muscles and nerves of the bladder. […] Retrograde ejaculation is neither dangerous nor painful and does not always require treatment. […] A 2017 study detailed a case in which retrograde ejaculation was the first and only symptom of type 1 diabetes. […] Retrograde ejaculation is not always reversible. However, the infertility it can cause is treatable.
#38 Retrograde ejaculation – UF Health
https://ufhealth.org/conditions-and-treatments/retrograde-ejaculation
Retrograde ejaculation occurs when semen goes backward into the bladder. Normally, it moves forward and out of the penis through the urethra during ejaculation. […] Retrograde ejaculation is uncommon. It most often occurs when the opening of the bladder (bladder neck) does not close. This causes semen to go backward into the bladder rather than forward out of the penis. […] Retrograde ejaculation that is caused by diabetes or surgery may be treated with drugs such as pseudoephedrine or imipramine. […] Retrograde ejaculation caused by surgery or diabetes often can’t be corrected. This is most often not a problem unless you are trying to conceive. Some men do not like how it feels and seek treatment. Otherwise, there is no need for treatment. […] The condition may cause infertility. However, semen can often be removed from the bladder and used during assistive reproductive techniques.
#39 Retrograde Ejaculation With Second-Generation Antipsychotics in Schizophrenia: A Case Series and Literature Review
https://www.psychiatrist.com/pcc/retrograde-ejaculation-second-generation-antipsychotics-schizophrenia/
The exact mechanism of retrograde ejaculation induced by antipsychotic medications still remains elusive; however, there are many reports that have implicated few of the most commonly used atypical antipsychotic medications such as risperidone, iloperidone, clozapine, quetiapine, and paliperidone as presented in Table 1. Among these atypical antipsychotic medications, there are more reports of RE associated with risperidone use. […] In general, the strategies to handle antipsychotic-induced RE are as follows: dose reduction of the offending drug, drug holidays wherein the offending drug will be discontinued 2 to 3 days before the anticipated sexual activity, adjunctive treatment with other medications, and switching to another antipsychotic drug. […] To summarize, RE is not uncommon among patients taking SGAs, it is generally evident by 2 weeks after its initiation, and certain SGAs could have a dose-dependent effect on RE.
#40 Retrograde Ejaculation – Harvard Health
https://www.health.harvard.edu/a_to_z/retrograde-ejaculation-a-to-z
In some men, retrograde ejaculation requires treatment because it interferes with fertility. This treatment varies depending on the cause. […] If your retrograde ejaculation is the result of damage to the nerves or muscles of your bladder, then it may not be possible to restore normal ejaculation. […] Simple therapies have a good chance of decreasing retrograde ejaculation enough to allow conception.
#41 :: WJMH :: World Journal of Men’s Health
https://wjmh.org/DOIx.php?id=10.5534/wjmh.210069
In patients with RE refractory to medical treatment, modified Hotchkiss procedure was utilized to retrieve sperm, and the retrieved sperm were frozen. The authors of the latter study indicated successful outcomes and healthy live births with the use of frozen sperm retrieved with modified Hotchkiss procedure for ICSI. An average live birth rate per transfer of 28% was reported in the latter study.
#42 Is Retrograde Ejaculation After Silodosin Reversible?
https://www.instituteofurology.in/is-retrograde-ejaculation-after-silodosin-reversible/
Silodosin is an alpha-1A adrenergic receptor antagonist that specifically targets alpha-1A receptors located in the smooth muscle of the prostate and bladder neck. […] However, this mechanism of action also disrupts the normal closure of the bladder neck during ejaculation. As a result, the retrograde flow of semen into the bladder occurs, leading to retrograde ejaculation. […] Several studies report high rates of retrograde ejaculation in men taking silodosin for BPH. […] According to a study published in the Journal of Sexual Medicine, retrograde ejaculation is the most frequent sexual side effect associated with silodosin. […] The good news is that retrograde ejaculation caused by silodosin is usually reversible once the medication is discontinued. […] The reversibility is attributed to the fact that silodosin’s effects on the alpha-1A receptors are temporary.