From the Research
Retrograde ejaculation occurs in approximately 7.7% of patients following bladder neck incision procedures, as reported in the most recent study 1. This complication is relatively common because the procedure involves cutting through the bladder neck and potentially disrupting the normal mechanisms that prevent semen from flowing backward into the bladder during ejaculation. The rates can vary depending on the specific technique used, with some studies suggesting lower rates of retrograde ejaculation, such as 8.6% in a study from 1989 2. However, the most recent study from 2023 1 provides the most up-to-date information on this topic, and its findings should be prioritized in clinical decision-making.
Some key points to consider when counseling patients about this potential side effect include:
- The mechanism behind retrograde ejaculation following bladder neck incision relates to damage to the internal urethral sphincter, which normally contracts during ejaculation to direct semen forward through the urethra.
- When this sphincter is compromised by the incision, semen can take the path of least resistance and flow backward into the bladder.
- While retrograde ejaculation is not harmful to health, it can cause infertility and may be psychologically distressing for some patients.
- Patients should be counseled about this potential side effect before undergoing the procedure, especially if fertility is a concern.
- The use of sperm cryopreservation before surgery for bladder neck obstruction should be encouraged, as suggested by the study from 2023 1.
It is also worth noting that there are treatment options available for retrograde ejaculation, such as the use of imipramine, as reported in a study from 1999 3, and surgical procedures like the Young-Dees operation, as reported in a study from 1986 4. However, these options should be considered on a case-by-case basis, and the most recent and highest-quality evidence should be prioritized in clinical decision-making.