From the Guidelines
If a patient's symptoms are not bothersome, watchful waiting is often appropriate, and no immediate treatment may be necessary. This approach is based on the principle of avoiding unnecessary treatment and potential side effects when symptoms don't impact quality of life, as supported by the most recent study 1. The patient should be monitored/observed if symptoms are mild or if the patient is opposed to treatment. Depending on the specific condition, follow-up appointments should be scheduled at appropriate intervals (typically every 3-12 months) to reassess symptoms and conduct any necessary evaluations. During these check-ups, the healthcare provider can perform relevant examinations and tests to ensure the condition remains stable.
- Regular monitoring is still recommended to track any potential progression of the underlying condition.
- Patients should be educated about warning signs that would warrant earlier medical attention, such as sudden worsening of symptoms, development of new symptoms, or changes in functional status.
- The patient should also understand that even asymptomatic conditions sometimes require treatment to prevent long-term complications, depending on the specific diagnosis and individual risk factors, as noted in 1. However, the most recent and highest quality study 1 suggests that watchful waiting is the preferred approach for patients with non-bothersome symptoms.
From the Research
Symptoms Not Bothersome
- If a patient's symptoms are not bothersome, the need for further action depends on the underlying condition causing the symptoms.
- In the case of retrograde ejaculation, which is a condition where semen enters the bladder instead of exiting through the penis during ejaculation, diagnosis and management may still be necessary even if symptoms are not bothersome 2, 3.
- This is because retrograde ejaculation can lead to infertility, and proper diagnosis and management can help improve fertility outcomes 4, 5.
- A study published in 2020 found that patients with retrograde ejaculation may not always experience bothersome symptoms, but still require proper diagnosis and management to address underlying issues 5.
- Another study published in 2025 emphasized the importance of proper diagnosis and management of retrograde ejaculation, even if symptoms are not bothersome, to improve fertility outcomes and quality of life for affected individuals 6.
Diagnostic Approaches
- Diagnostic approaches for retrograde ejaculation may involve laboratory analysis of post-ejaculatory urine samples, advanced imaging techniques, and patient history 2, 6.
- A study published in 2024 found that transrectal color Doppler ultrasound can be used to track the ejaculation process in real-time and diagnose retrograde ejaculation 4.
- Another study published in 2020 found that postorgasm seminal vesicle volume can be used to differentiate between retrograde ejaculation and anejaculation in patients with ejaculatory disorders 5.
Management Strategies
- Management strategies for retrograde ejaculation may include pharmacological interventions, surgical approaches, and assisted reproductive technologies (ARTs) 3, 6.
- A study published in 1987 found that successful recovery of live spermatozoa from post-ejaculatory urine for artificial insemination is dependent on careful regulation of pH and osmolarity of the urine and separation of motile spermatozoa from debris and cells 3.
- Another study published in 2025 emphasized the importance of refining diagnostic tools, optimizing ART protocols, and developing minimally invasive treatments to improve fertility outcomes for patients with retrograde ejaculation 6.