Signs of Retrograde Ejaculation
The primary sign of retrograde ejaculation is decreased or absent ejaculate volume (dry ejaculation) despite normal orgasmic sensation, with spermatozoa found in post-ejaculatory urine samples. 1, 2
Clinical Presentation
Primary Signs
- Decreased or absent ejaculate volume (partial or complete retrograde ejaculation)
- Normal orgasmic sensation despite little to no ejaculate
- Cloudy urine after orgasm/ejaculation
- Infertility without other obvious causes
Secondary Signs and Symptoms
- Normal erectile function
- Normal libido
- No pain during orgasm
- Post-orgasmic urine containing spermatozoa (diagnostic confirmation)
Diagnostic Evaluation
History
- Surgical history: Previous prostate surgery, retroperitoneal lymph node dissection (RPLND), or bladder neck surgery 3
- Medical conditions: Diabetes mellitus (neuropathy affecting sympathetic fibers to bladder neck) 4
- Medications: Alpha-blockers, antipsychotics, or other medications affecting sympathetic nervous system
- Neurological disorders: Spinal cord injury or multiple sclerosis
Physical Examination
- Normal testicular examination in most cases
- Assess for neurological deficits that might affect ejaculatory function
Laboratory Testing
Semen analysis:
- Low or absent semen volume (<1.5 mL)
- Azoospermia or severe oligozoospermia
Post-ejaculatory urine analysis:
Differential Diagnosis
- Ejaculatory duct obstruction
- Anejaculation
- Hypogonadism
- Delayed ejaculation
Complications
- Infertility: Major consequence requiring specialized treatment 5
- Psychological distress: Related to altered sexual function and infertility concerns 2
Management Considerations
- Pharmacological treatment: Sympathomimetics or anticholinergics may help in some cases 2
- Sperm retrieval techniques: For fertility purposes, sperm can be retrieved from post-ejaculatory urine 1, 5
- Assisted reproductive techniques: Intrauterine insemination or in vitro fertilization with retrieved sperm 6
Pitfalls and Caveats
- Retrograde ejaculation may be misdiagnosed as azoospermia if post-ejaculatory urine is not examined
- The condition may be partial or complete, with varying degrees of ejaculate volume reduction
- Surgical procedures like retroperitoneal lymph node dissection (RPLND) carry a high risk of retrograde ejaculation (up to 80% with standard technique) 3
- Nerve-sparing surgical techniques can preserve antegrade ejaculation in approximately 90% of cases 3
Remember that retrograde ejaculation itself is not harmful to health but primarily affects fertility and may cause psychological distress due to the altered sexual experience and potential fertility concerns.