Differential Diagnosis for Ejaculatory Leakage
The following differential diagnosis is organized into categories to help guide the thought process:
- Single Most Likely Diagnosis
- Posterior urethral disruption or injury: This is a common cause of ejaculatory leakage, especially in the context of pelvic trauma or instrumentation. The posterior urethra is prone to injury, which can lead to leakage of semen during ejaculation.
- Other Likely Diagnoses
- Prostate surgery complications (e.g., transurethral resection of the prostate, prostatectomy): Surgical interventions in the prostate area can damage the surrounding tissues, leading to ejaculatory leakage.
- Urethral stricture or stenosis: Narrowing of the urethra can cause semen to leak out during ejaculation.
- Neurogenic bladder or neurological disorders (e.g., multiple sclerosis, spinal cord injury): Neurological conditions can affect the bladder and urethral sphincter, leading to ejaculatory leakage.
- Do Not Miss Diagnoses
- Urethral cancer: Although rare, urethral cancer can cause ejaculatory leakage and is a critical diagnosis not to miss due to its potential for severe consequences if left untreated.
- Prostate cancer: Prostate cancer can invade the surrounding tissues, including the urethra, leading to ejaculatory leakage.
- Rare Diagnoses
- Congenital urethral anomalies (e.g., urethral duplication, urethral diverticulum): Rare congenital conditions can affect the urethra and lead to ejaculatory leakage.
- Inflammatory or infectious conditions (e.g., prostatitis, urethritis): Certain infections or inflammatory conditions can cause damage to the urethra or surrounding tissues, leading to ejaculatory leakage.
- Amyloidosis or other systemic diseases affecting the urethra: Systemic diseases can deposit abnormal proteins or cause inflammation in the urethra, leading to ejaculatory leakage.