From the Research
For a 76-year-old male with retrograde ejaculation and no desire for children, the best treatment approach is typically conservative management since fertility is not a concern. Pharmacological options include alpha-adrenergic agonists such as pseudoephedrine (30-60 mg taken 2-3 hours before sexual activity) or imipramine (25-50 mg daily) 1. These medications work by increasing the tone of the bladder neck and internal sphincter, which may help prevent semen from entering the bladder during ejaculation. However, these medications should be used cautiously in elderly patients, especially those with hypertension, cardiovascular disease, or prostatic hyperplasia, as they can cause side effects like increased blood pressure, urinary retention, or cardiac issues. Some key points to consider in the management of retrograde ejaculation include:
- Addressing any underlying causes such as diabetes, neurological conditions, or medication side effects (particularly alpha-blockers used for prostate conditions) 2.
- Discussing potential medication adjustments with the prescribing physician if the retrograde ejaculation is medication-induced.
- Regular follow-up to monitor for any changes in urinary symptoms or sexual function. It's also important to note that some studies have shown the efficacy of pseudoephedrine in treating retrograde ejaculation, with improvements in seminal parameters observed in a significant proportion of patients 1. In the context of this patient, where fertility is not a concern, conservative management with reassurance and monitoring for any changes in symptoms is likely the most appropriate approach, given the potential risks associated with pharmacological treatment in elderly patients 3, 4.