Retrograde ejaculation is a violation of the ejaculation mechanism, in which the ejaculation of seminal fluid occurs in the proximal direction into the bladder. Disease is accompanied by the absence of ejaculation of sperm from the urethra during orgasm, the release of cloudy urine after ejaculation, male infertility. The diagnosis is confirmed by the detection of spermatozoa in post-ejaculatory urine analysis and the identification of organic, neurological, pharmacological and other causes of this form of sexual dysfunction. Treatment is to normalize the ejaculation process using conservative or surgical methods.
Retrograde ejaculation is an ejaculation disorders, accompanied by an incorrect passage of seminal fluid, as a result of which the ejaculate enters the bladder cavity. With normal, antegrade ejaculation, at the moment of ejaculation, the muscles of the neck of the bladder contract, which prevents sperm from being thrown into the bladder. Seminal fluid is released into the posterior urethra, after which, as a result of contraction of the bulbous-cavernous muscles and perineal muscles, it is expelled from the external opening of the urethra. With retrograde ejaculation, the sphincter of the neck of the bladder does not contract, so the seminal fluid flows into the bladder. Pathology can be partial if part of the seminal fluid enters the urethra and part into the bladder, or complete when all the seminal fluid enters the bladder. In urology and andrology, retrograde ejaculation refers to rare forms of ejaculation disorders, which occurs in about 1% of men.
The causes of retrograde ejaculation may be associated with congenital and acquired pathology of the urethra and bladder. In the first case, the reverse casting of seminal fluid is a consequence of congenital malformations of the genitourinary organs: the presence of urethral valves, anomalies of the urinary triangle and vas deferens, bladder exstrophy. Acquired anatomical prerequisites leading to disease may include urethral stricture, sclerotic changes in the neck of the bladder, pelvic venous congestion syndrome. Sometimes retrograde ejaculation is directly related to hormonal and organic changes occurring in the body during the male menopause.
Iatrogenic factors, including various surgical interventions on the organs of the abdominal cavity and pelvis, can lead to secondary (acquired) retrograde ejaculation. These include the consequences of transurethral resection of the prostate, suprapubic adenomectomy, prostatectomy, bladder TUR, sympathectomy, retroperitoneal lymph dissection, operations on the sigmoid and rectum, anal region. Neurological diseases can play an etiological role in the occurrence of this disease: diabetic neuropathy, spinal cord injuries, multiple sclerosis, etc.
Retrograde ejaculation may be associated with the side effect of pharmacological drugs taken that cause paresis of the bladder neck: hypotensive, antipsychotic drugs, antidepressants, alpha-blockers, etc. All cases of retrograde ejaculation of unknown etiology are idiopathic.
A violation of ejaculation by the type of retrograde ejaculation is indicated by a small amount (1-2 ml) of sperm ejected from the urethra at the climax of sexual intercourse, or its complete absence (“dry” orgasm). Due to the casting of seminal fluid into the bladder, the urine released after sexual intercourse has a cloudy character.
By itself, retrograde ejaculation does not harm men’s health, does not affect erection, does not cause pain, does not reduce the degree of sexual satisfaction. At the same time, if a married couple strives for the birth of a child, the full form makes conception naturally impossible, i.e. it becomes an etiological factor of male infertility. In addition, the absence of normal ejaculation can have a negative impact on a man’s self-esteem, contribute to the development of complexes and doubts about male usefulness.
Retrograde ejaculation is usually diagnosed in men who have turned to a urologist or andrologist with complaints about the lack of sperm or a decrease in its quantity, or unsuccessful attempts at conception (in the absence of confirmed female infertility). Primary medical consultation includes the study of anamnesis, manual examination of the prostate gland, drawing up a diagnostic algorithm.
The main way to detect retrograde ejaculation is to conduct a post-ejaculatory urine analysis, in which microscopic examination of the sediment reveals spermatozoa and other substances that make up the seminal fluid. With partial retrograde ejaculation and the possibility of obtaining an ejaculate, a spermogram is examined (to exclude azoospermia), sperm biochemistry, a test of sperm contact with cervical mucus, etc. To exclude organic causes of retrograde ejaculation, bladder ultrasound, prostate ultrasound, urethroscopy, electromyography, electroneurography, etc. are performed. Retrograde ejaculation must be distinguished from aneaculation (absence of ejaculation), when spermatozoa are not detected in the urine.
The goal of retrograde ejaculation treatment is to restore antegrade ejaculation. Depending on the cause of ejaculation disorders, this can be achieved by conservative or surgical methods. If the pharmacological causes leading to retrograde ejaculation are identified, the drug having this side effect is canceled or replaced. As part of conservative therapy, acupuncture, physiotherapy procedures, electrical stimulation of the urethra and bladder are prescribed. In order to prevent retrograde casting of seminal fluid, sexual intercourse is recommended to be performed with a filled bladder. For drug therapy of retrograde ejaculation, according to indications, drugs that affect the tone of the bladder sphincter (ephedrine sulfate, midodrine, etc.) are used. In some cases, the causes of retrograde ejaculation can only be eliminated surgically with the help of bladder sphincteroplasty, urethral plasty and reconstruction of urethral strictures, etc.
In situations where it is impossible to achieve antegrade ejaculation, the realization of a man’s reproductive plans is possible with the help of ART methods. In this case, spermatozoa can be obtained from a post-ejaculatory urine sample collected by catheterization of the bladder. In the future, based on the individual situation, intrauterine insemination or in vitro fertilization is performed, or (with low sperm counts) ICSI procedure.
Prognosis and prevention
In most cases, disease does not have a negative effect on a man’s sexual function. At the same time, this condition can cause psychological complexes and fertility disorders, and therefore needs correction. If it is impossible to cure retrograde ejaculation in order to realize the reproductive potential of a man, it is possible to resort to IVF.
Prevention of acquired retrograde ejaculation should include the correct selection of dosage of medications for the treatment of concomitant diseases, control of the level of glycemia in diabetes mellitus. If it is necessary to perform surgery on the neck of the bladder or prostate, preference should be given to minimally invasive surgical procedures that pose a lower risk of retrograde ejaculation.