From the Guidelines
Retrograde ejaculation should be treated with sympathomimetics and alkalinization of urine with or without urethral catheterization, induced ejaculation, or surgical sperm retrieval, as these methods have shown promise in addressing infertility associated with this condition 1. The diagnosis of retrograde ejaculation typically involves a physical examination, medical history, and laboratory tests to rule out other conditions. Symptoms of retrograde ejaculation include cloudy urine after orgasm, dry orgasms, and reduced or no semen during ejaculation. Some key points to consider in the treatment of retrograde ejaculation include:
- Medications like pseudoephedrine, imipramine, or chlorpheniramine may be used to strengthen bladder neck closure and improve symptoms 1.
- For fertility concerns, sperm can be retrieved from post-orgasm urine samples for assisted reproduction, and techniques like microdissection-testicular sperm extraction (micro-TESE) may be considered for men with non-obstructive azoospermia 1.
- Lifestyle adjustments are not typically effective, but treating underlying conditions like diabetes may improve symptoms.
- Patients should consult healthcare providers for personalized treatment, especially if fertility is desired. In terms of specific treatment options, sympathomimetics like pseudoephedrine (30-60mg taken 2-2.5 hours before intercourse) may be a viable option for some patients 1. Additionally, alkalinization of urine with or without urethral catheterization may also be considered, depending on the patient's condition and clinician's experience 1.
From the Research
Diagnosis of Retrograde Ejaculation
- Retrograde ejaculation (RE) is a condition defined as the backward flow of the semen during ejaculation, and when present can result in male infertility 2.
- RE may be partial or complete, resulting in either low seminal volume or complete absence of the ejaculate (dry ejaculate) 2.
- The diagnosis of RE involves evaluating the cause of the condition, which can be anatomic, neurological, or pharmacological 2.
Treatment of Retrograde Ejaculation
- Medical treatment for RE in diabetic patients is a promising method and should be the first line of treatment in these cases 3.
- Different therapeutic approaches are present, including medical and surgical treatments, with limited success rates 3.
- Imipramine and pseudoephedrine are two drugs that have been used to treat RE, with imipramine being successful in producing antegrade ejaculate in 38.5% of patients with complete RE, and pseudoephedrine being successful in 47.8% of patients 3.
- Combination of imipramine and pseudoephedrine was successful in 61.5% of patients with complete RE 3.
- Alkalinizing urinary pH with oral medications or by adding sperm wash media into the bladder prior to ejaculation may preserve the viability of the sperm 2.
- Ephedrine sulfate and imipramine hydrochloride have also been used to treat RE, with positive results obtained in 29.3% of patients 4.
- Methoxamine, a pure alpha1-adrenergic agonist, has been used to treat RE, with substantial increase in sperm count and successful clinical pregnancies 5.
- Imipramine has also been used to treat RE caused by retroperitoneal surgery, with antegrade ejaculation induced in all 11 patients treated 6.