Can radical prostatectomy cause retrograde ejaculation?

Retrograde Ejaculation After Radical Prostatectomy

No, you cannot have retrograde ejaculation following radical prostatectomy because the prostate and seminal vesicles—which produce the ejaculate—are completely removed during the procedure, resulting in anejaculation (complete absence of ejaculate) rather than retrograde flow. 1

Understanding the Distinction

What Actually Happens After Radical Prostatectomy

• Anejaculation is universal after radical prostatectomy because the prostate gland and seminal vesicles that produce semen are surgically removed 1
• Men can still achieve orgasm after surgery, but this occurs without any ejaculation (neither antegrade nor retrograde) 1
• The ability to achieve orgasm is often preserved even without an erection 1

Retrograde Ejaculation vs. Anejaculation

Retrograde ejaculation occurs when ejaculate flows backward into the bladder rather than out through the urethra. This happens when:

• The bladder neck mechanism fails to close properly during ejaculation 2
• The anatomical structures remain intact but function abnormally 2
• This is the typical complication after transurethral resection of the prostate (TURP) for benign prostatic hyperplasia, not radical prostatectomy 1, 2, 3

Anejaculation means complete absence of ejaculate because:

• The organs producing seminal fluid have been removed 1
• There is no fluid to ejaculate in either direction 1

Common Pitfall: Climacturia

What Patients May Actually Experience

• Climacturia (orgasm-associated urinary incontinence) occurs in up to 30% of men following radical prostatectomy 1, 4, 5
• This involves urine leakage at orgasm, not ejaculate 1, 6
• Patients may confuse this urinary leakage with ejaculation, but it is fundamentally different 6

Risk Factors for Climacturia

• Time since surgery (more common within the first year) 1
• Prior transurethral resection of the prostate 1
• Shorter functional urethral length following surgery 1
• Shorter penile length after surgery 1

Management of Climacturia

• Empty the bladder before sexual activity 1, 4, 5
• Use condoms during sexual activity 1, 4, 5
• Consider penile variable tension loop devices 4, 5
• Implement pelvic floor muscle exercises 4, 5

Procedures That DO Cause Retrograde Ejaculation

TURP and Related Procedures

• Transurethral resection of the prostate for benign prostatic hyperplasia commonly causes retrograde ejaculation 1, 2, 3
• The bladder neck is disrupted during TURP, preventing normal closure during ejaculation 1, 3
• The vast majority of men undergoing classical TURP techniques experience permanent retrograde ejaculation 3
• Modified techniques (such as bladder neck-sparing approaches) can reduce but not eliminate this risk 7

Other Causes

• Retroperitoneal lymph node dissection 2
• Diabetic neuropathy 2
• These conditions affect the neurological control of the bladder neck without removing ejaculate-producing organs 2

Clinical Counseling Points

• Preoperatively, patients must understand that radical prostatectomy results in permanent anejaculation, not retrograde ejaculation 1
• Men who have same-sex partners are significantly more bothered by loss of ejaculate than heterosexual men and are at greater risk of depression or anxiety 1
• The psychological impact of anejaculation should not be trivialized, as it can significantly affect quality of life and sexual satisfaction 3
• Age, preoperative erectile function, and nerve-sparing status do not significantly affect the occurrence of anejaculation (which is universal) but do affect climacturia risk 1