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Ejaculatory Dysfunction: Retrograde Ejaculation

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The Diagnosis and Treatment of Male Infertility

Abstract

Retrograde ejaculation is a relatively rare cause of male infertility. Yet, as one of the few pathologies in male infertility that can in some cases be successfully treated with medications, it is important for the clinician to be able to diagnose and treat this entity. Recent studies have demonstrated findings pertaining to the cause and mechanism of retrograde ejaculation that run contrary to classical teaching. This chapter will examine these findings and review the causes, workup, diagnosis, and treatment for retrograde ejaculation. A clinical vignette of a common presentation of retrograde ejaculation is presented and workup, diagnosis, and treatment are discussed.

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References

  1. Sigman M. Introduction: ejaculatory problems and male infertility. Fertil Steril. 2015;104(5):1049–50.

    Article  PubMed  Google Scholar 

  2. Okada H, Fujioka H, Tatsumi N, Kanzaki M, Inaba Y, Fujisawa M, et al. Treatment of patients with retrograde ejaculation in the era of modern assisted reproduction technology. J Urol. 1998;159(3):848–50.

    Article  CAS  PubMed  Google Scholar 

  3. Yavetz H, Yogev L, Hauser R, Lessing JB, Paz G, Homonnai ZT. Retrograde ejaculation. Hum Reprod. 1994;9(3):381–6.

    Article  CAS  PubMed  Google Scholar 

  4. Alwaal A, Breyer BN, Lue TF. Normal male sexual function: emphasis on orgasm and ejaculation. Fertil Steril. 2015;104(5):1051–60.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Nagai A, Watanabe M, Nasu Y, Iguchi H, Kusumi N, Kumon H. Analysis of human ejaculation using color doppler ultrasonography: a comparison between antegrade and retrograde ejaculation. Urology. 2005;65(2):365–8.

    Article  PubMed  Google Scholar 

  6. Aust TR, Brookes S, Troup SA, Fraser WD, Lewis-Jones DI. Development and in vitro testing of a new method of urine preparation for retrograde ejaculation; the Liverpool solution. Fertil Steril. 2008;89(4):885–91.

    Article  PubMed  Google Scholar 

  7. Crich JP, Jequier AM. Infertility in men with retrograde ejaculation: the action of urine on sperm motility, and a simple method for achieving antegrade ejaculation. Fertil Steril. 1978;30(5):572–6.

    Article  CAS  PubMed  Google Scholar 

  8. Makler A, David R, Blumenfeld Z, Better OS. Factors affecting sperm motility. Vii. Sperm viability as affected by change of ph and osmolarity of semen and urine specimens. Fertil Steril. 1981;36(4):507–11.

    Article  CAS  PubMed  Google Scholar 

  9. Practice Committee of the American Society for Reproductive Medicine. Diagnostic evaluation of the infertile male: a committee opinion. Fertil Steril. 2015;103(3):e18–25.

    Article  Google Scholar 

  10. Engelbertz F, Korda JB, Engelmann U, Rothschild M, Banaschak S. Longevity of spermatozoa in the post-ejaculatory urine of fertile men. Forensic Sci Int. 2010;194(1–3):15–9.

    Article  PubMed  Google Scholar 

  11. Mehta A, Jarow JP, Maples P, Sigman M. Defining the “normal” postejaculate urinalysis. J Androl. 2012 Sep-Oct;33(5):917–20.

    Google Scholar 

  12. Sigman M, Boyle K, Jarow JP. Prevalence of sperm in the post-ejaculatory urine of fertile and subfertile men. Urology. 2008;71(1):110–2.

    Article  PubMed  Google Scholar 

  13. Vinik AI, Maser RE, Mitchell BD, Freeman R. Diabetic autonomic neuropathy. Diabetes Care. 2003;26(5):1553–79.

    Article  PubMed  Google Scholar 

  14. Wei DY, Drake MJ. Undiagnosed neurological disease as a potential cause of male lower urinary tract symptoms. Curr Opin Urol. 2016;26(1):11–6.

    Article  PubMed  Google Scholar 

  15. Dinulovic D, Radonjic G. Diabetes mellitus/male infertility. Arch Androl. 1990;25(3):277–93.

    Article  CAS  PubMed  Google Scholar 

  16. Fedder J, Kaspersen MD, Brandslund I, Hojgaard A. Retrograde ejaculation and sexual dysfunction in men with diabetes mellitus: a prospective, controlled study. Andrology. 2013;1(4):602–6.

    Article  CAS  PubMed  Google Scholar 

  17. Delfino M, Imbrogno N, Elia J, Capogreco F, Mazzilli F. Prevalence of diabetes mellitus in male partners of infertile couples. Minerva urologica e nefrologica Ital J Urol Nephrol. 2007;59(2):131–5.

    CAS  Google Scholar 

  18. Mulholland J, Mallidis C, Agbaje I, McClure N. Male diabetes mellitus and assisted reproduction treatment outcome. Reprod Biomed Online. 2011;22(2):215–9.

    Article  PubMed  Google Scholar 

  19. Sexton WJ, Jarow JP. Effect of diabetes mellitus upon male reproductive function. Urology. 1997;49(4):508–13.

    Article  CAS  PubMed  Google Scholar 

  20. Gaunay G, Nagler HM, Stember DS. Reproductive sequelae of diabetes in male patients. Endocrinol Metab Clin North Am. 2013;42(4):899–914.

    Article  PubMed  Google Scholar 

  21. Hennessey A, Robertson NP, Swingler R, Compston DA. Urinary, faecal and sexual dysfunction in patients with multiple sclerosis. J Neurol. 1999;246(11):1027–32.

    Article  CAS  PubMed  Google Scholar 

  22. Zorzon M, Zivadinov R, Bosco A, Bragadin LM, Moretti R, Bonfigli L, et al. Sexual dysfunction in multiple sclerosis: a case-control study. I. Frequency and comparison of groups. Multiple Sclerosis. 1999;5(6):418–27.

    CAS  PubMed  Google Scholar 

  23. Marra G, Sturch P, Oderda M, Tabatabaei S, Muir G, Gontero P. Systematic review of lower urinary tract symptoms/benign prostatic hyperplasia surgical treatments on men’s ejaculatory function: time for a bespoke approach? Int J Urol (Official Journal of the Japanese Urological Association). 2016;23(1):22–35.

    Article  Google Scholar 

  24. Woo HH, Bolton DM, Laborde E, Jack G, Chin PT, Rashid P, et al. Preservation of sexual function with the prostatic urethral lift: a novel treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia. J Sex Med. 2012;9(2):568–75.

    Article  PubMed  Google Scholar 

  25. Baniel J, Sella A. Complications of retroperitoneal lymph node dissection in testicular cancer: primary and post-chemotherapy. Semin Surg Oncol. 1999;17(4):263–7.

    Article  CAS  PubMed  Google Scholar 

  26. Pearce S, Steinberg Z, Eggener S. Critical evaluation of modified templates and current trends in retroperitoneal lymph node dissection. Current Urol Reports. 2013;14(5):511–7.

    Article  Google Scholar 

  27. Beck SD, Bey AL, Bihrle R, Foster RS. Ejaculatory status and fertility rates after primary retroperitoneal lymph node dissection. J Urol. 2010;184(5):2078–80.

    Article  PubMed  Google Scholar 

  28. Masterson TA, Cary C, Rice KR, Foster RS. The evolution and technique of nerve-sparing retroperitoneal lymphadenectomy. Urol Clin North Am. 2015;42(3):311–20.

    Article  PubMed  Google Scholar 

  29. Sanbe A, Tanaka Y, Fujiwara Y, Tsumura H, Yamauchi J, Cotecchia S, et al. Alpha1-adrenoceptors are required for normal male sexual function. Br J Pharmacol. 2007;152(3):332–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Hisasue S, Furuya R, Itoh N, Kobayashi K, Furuya S, Tsukamoto T. Ejaculatory disorder caused by alpha-1 adrenoceptor antagonists is not retrograde ejaculation but a loss of seminal emission. Int J Urol (Official Journal of the Japanese Urological Association). 2006;13(10):1311–6.

    Article  CAS  Google Scholar 

  31. Hellstrom WJ, Sikka SC. Effects of acute treatment with tamsulosin versus alfuzosin on ejaculatory function in normal volunteers. J Urol. 2006;176(4 Pt 1):1529–33.

    Article  CAS  PubMed  Google Scholar 

  32. Kobayashi K, Masumori N, Hisasue S, Kato R, Hashimoto K, Itoh N, et al. Inhibition of seminal emission is the main cause of anejaculation induced by a new highly selective alpha1a-blocker in normal volunteers. J Sex Med. 2008;5(9):2185–90.

    Article  PubMed  Google Scholar 

  33. Kaplan SA. Side effects of alpha-blocker use: retrograde ejaculation. Rev Urol. 2009 Fall;11(Suppl 1):S14–8.

    Google Scholar 

  34. Mizoguchi Y. Levomepromazine-induced retrograde ejaculation. J Neuropsychiatry Clin Neurosci. 2012 Winter;24(1):E32.

    Google Scholar 

  35. Freeman SA. Iloperidone-induced retrograde ejaculation. Int Clin Psychopharmacol. 2013;28(3):156.

    Article  PubMed  Google Scholar 

  36. Jeffries JJ, Vanderhaeghe L, Remington GJ, Al-Jeshi A. Clozapine-associated retrograde ejaculation. Can J Psychiatry Revue canadienne de psychiatrie. 1996;41(1):62–3.

    CAS  PubMed  Google Scholar 

  37. Kandasamy A. Paliperidone as an alternative for risperidone in a case of schizophrenia with retrograde ejaculation. J Neuropsychiatry Clin Neurosci. 2012 Summer;24(3):E17–8.

    Google Scholar 

  38. Loh C, Leckband SG, Meyer JM, Turner E. Risperidone-induced retrograde ejaculation: case report and review of the literature. Int Clin Psychopharmacol. 2004;19(2):111–2.

    Article  PubMed  Google Scholar 

  39. Shiloh R, Weizman A, Weizer N, Dorfman-Etrog P, Munitz H. Risperidone-induced retrograde ejaculation. Am J Psychiatry. 2001;158(4):650.

    Article  CAS  PubMed  Google Scholar 

  40. Peuskens J, Pani L, Detraux J, De Hert M. The effects of novel and newly approved antipsychotics on serum prolactin levels: a comprehensive review. CNS Drugs. 2014;28(5):421–53.

    CAS  PubMed  PubMed Central  Google Scholar 

  41. Brackett NL, Ferrell SM, Aballa TC, Amador MJ, Padron OF, Sonksen J, et al. An analysis of 653 trials of penile vibratory stimulation in men with spinal cord injury. J Urol. 1998;159(6):1931–4.

    Article  CAS  PubMed  Google Scholar 

  42. McGuire C, Manecksha RP, Sheils P, McDermott TE, Grainger R, Flynn R. Electroejaculatory stimulation for male infertility secondary to spinal cord injury: the Irish experience in national rehabilitation hospital. Urology. 2011;77(1):83–7.

    Article  PubMed  Google Scholar 

  43. Heruti RJ, Katz H, Menashe Y, Weissenberg R, Raviv G, Madjar I, et al. Treatment of male infertility due to spinal cord injury using rectal probe electroejaculation: the Israeli experience. Spinal Cord. 2001;39(3):168–75.

    Article  CAS  PubMed  Google Scholar 

  44. Brindley GS. Reflex ejaculation under vibratory stimulation in paraplegic men. Paraplegia. 1981;19(5):299–302.

    Article  CAS  PubMed  Google Scholar 

  45. Schurch B, Yasuda K, Rossier AB. Detrusor bladder neck dyssynergia revisited. J Urol. 1994;152(6 Pt 1):2066–70.

    CAS  PubMed  Google Scholar 

  46. Soler JM, Previnaire JG. Ejaculatory dysfunction in spinal cord injury men is suggestive of dyssynergic ejaculation. Eur J Phys Rehabil Med. 2011;47(4):677–81.

    CAS  PubMed  Google Scholar 

  47. Sonksen J, Ohl DA, Wedemeyer G. Sphincteric events during penile vibratory ejaculation and electroejaculation in men with spinal cord injuries. J Urol. 2001;165(2):426–9.

    Article  CAS  PubMed  Google Scholar 

  48. Shibahara H, Toji H, Shigeta M, Yoshimoto T, Shima H, Koyama K. Successful pregnancies in a case of retrograde ejaculation associated with tethered spinal cord syndrome. J Assist Reprod Genet. 2000;17(4):233–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Singh PK, Singh VK, Azam A, Gupta S. Tarlov cyst and infertility. J Spinal Cord Med. 2009;32(2):191–7.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Templeton A, Mortimer D. Successful circumvention of retrograde ejaculation in an infertile diabetic man. Case report. Br J Obstet Gynaecol. 1982;89(12):1064–5.

    Article  CAS  PubMed  Google Scholar 

  51. Leiva R. Retrograde ejaculation: simpler treatment. Fertil Steril. 2007 Jul;88(1):212 e213–4.

    Google Scholar 

  52. Marmar JL, Praiss DE, DeBenedictis TJ. Postcoital-voiding insemination: technique for patients with retrograde ejaculation and infertility. Urology. 1977;9(3):288–90.

    Article  CAS  PubMed  Google Scholar 

  53. Cleine JH. Retrograde ejaculation: can sperm retrieval be simpler and noninvasive? Fertil Steril. 2000;74(2):416–7.

    Article  CAS  PubMed  Google Scholar 

  54. Gilja I, Parazajder J, Radej M, Cvitkovic P, Kovacic M. Retrograde ejaculation and loss of emission: possibilities of conservative treatment. Eur Urol. 1994;25(3):226–8.

    CAS  PubMed  Google Scholar 

  55. Kamischke A, Nieschlag E. Update on medical treatment of ejaculatory disorders. Int J Androl. 2002;25(6):333–44.

    Article  CAS  PubMed  Google Scholar 

  56. Arafa M, El Tabie O. Medical treatment of retrograde ejaculation in diabetic patients: a hope for spontaneous pregnancy. J Sex Med. 2008;5(1):194–8.

    Article  CAS  PubMed  Google Scholar 

  57. Hsiao W, Deveci S, Mulhall JP. Outcomes of the management of post-chemotherapy retroperitoneal lymph node dissection-associated anejaculation. BJU Int. 2012;110(8):1196–200.

    Article  PubMed  Google Scholar 

  58. Tomasi PA, Fanciulli G, Delitala G. Successful treatment of retrograde ejaculation with the alpha1-adrenergic agonist methoxamine: Case study. Int J Impot Res. 2005 May-Jun;17(3):297–299..

    Google Scholar 

  59. Ochsenkuhn R, Kamischke A, Nieschlag E. Imipramine for successful treatment of retrograde ejaculation caused by retroperitoneal surgery. Int J Androl. 1999;22(3):173–7.

    Article  CAS  PubMed  Google Scholar 

  60. Andaloro VA Jr, Dube A. Treatment of retrograde ejaculation with brompheniramine. Urology. 1975;5(4):520–2.

    Article  PubMed  Google Scholar 

  61. Nikolettos N, Al-Hasani S, Baukloh V, Schopper B, Demirel LC, Baban N, et al. The outcome of intracytoplasmic sperm injection in patients with retrograde ejaculation. Hum Reprod. 1999;14(9):2293–6.

    Article  CAS  PubMed  Google Scholar 

  62. Saito K, Kinoshita Y, Yumura Y, Iwasaki A, Hosaka M. Successful pregnancy with sperm retrieved from the bladder after the introduction of a low-electrolyte solution for retrograde ejaculation. Fertil Steril. 1998;69(6):1149–51.

    Article  CAS  PubMed  Google Scholar 

  63. Scammell GE, Stedronska-Clark J, Edmonds DK, Hendry WF. Retrograde ejaculation: Successful treatment with artificial insemination. Br J Urol. 1989;63(2):198–201.

    Article  CAS  PubMed  Google Scholar 

  64. Zhao Y, Garcia J, Jarow JP, Wallach EE. Successful management of infertility due to retrograde ejaculation using assisted reproductive technologies: a report of two cases. Arch Androl. 2004 Nov-Dec;50(6):391–394..

    Google Scholar 

  65. Scammell GE. Successful treatment of infertility due to retrograde ejaculation. J R Soc Med. 1981;74(12):926–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  66. Philippon M, Karsenty G, Bernuz B, Courbiere B, Brue T, Saias-Magnan J, et al. Successful pregnancies and healthy live births using frozen-thawed sperm retrieved by a new modified hotchkiss procedure in males with retrograde ejaculation: first case series. Basic Clin Androl. 2015;25:5.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Jimenez C, Grizard G, Pouly JL, Boucher D. Birth after combination of cryopreservation of sperm recovered from urine and intracytoplasmic sperm injection in a case of complete retrograde ejaculation. Fertil Steril. 1997;68(3):542–4.

    Article  CAS  PubMed  Google Scholar 

  68. Jefferys A, Siassakos D, Wardle P. The management of retrograde ejaculation: a systematic review and update. Fertil Steril. 2012;97(2):306–12.

    Article  PubMed  Google Scholar 

  69. Middleton RG, Urry RL. The young-dees operation for the correction of retrograde ejaculation. J Urol. 1986;136(6):1208–9.

    CAS  PubMed  Google Scholar 

  70. Ramadan AE, el-Demiry MI, Ramadan AE. Surgical correction of post-operative retrograde ejaculation. Br J Urol. 1985 Aug;57(4):458–61.

    Google Scholar 

  71. Abrahams JI, Solish GI, Boorjian P, Waterhouse RK. The surgical correction of retrograde ejaculation. J Urol. 1975;114(6):888–90.

    CAS  PubMed  Google Scholar 

  72. Kurbatov D, Russo GI, Galstyan GR, Rozhivanov R, Lepetukhin A, Dubsky S, et al. Correction of retrograde ejaculation in patients with diabetes mellitus using endourethral collagen injection: preliminary results. J Sex Med. 2015;12(11):2126–9.

    Article  CAS  PubMed  Google Scholar 

  73. Nagai A, Nasu Y, Watanabe M, Tsugawa M, Iguchi H, Kumon H. Analysis of retrograde ejaculation using color doppler ultrasonography before and after transurethral collagen injection. Int J Impot Res. 2004;16(5):456–8.

    Article  CAS  PubMed  Google Scholar 

  74. Reynolds JC, McCall A, Kim ED, Lipshultz LI. Bladder neck collagen injection restores antegrade ejaculation after bladder neck surgery. J Urol. 1998;159(4):1303.

    Article  CAS  PubMed  Google Scholar 

  75. Belker AM, Sherins RJ, Bustillo M, Calvo L. Pregnancy with microsurgical vas sperm aspiration from a patient with neurologic ejaculatory dysfunction. J Androl. 1994 Nov-Dec;15 Suppl:6S-9S.

    Google Scholar 

  76. Tsirigotis M, Pelekanos M, Beski S, Gregorakis S, Foster C, Craft IL. Cumulative experience of percutaneous epididymal sperm aspiration (pesa) with intracytoplasmic sperm injection. J Assist Reprod Genet. 1996;13(4):315–9.

    Article  CAS  PubMed  Google Scholar 

  77. Rosenlund B, Sjoblom P, Tornblom M, Hultling C, Hillensjo T. In-vitro fertilization and intracytoplasmic sperm injection in the treatment of infertility after testicular cancer. Hum Reprod. 1998;13(2):414–8.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Loma Linda University Medical Center, 11234 Anderson Street, Room A560, Loma Linda, CA, 92354, USA

    Jim K. Shen, Salim K. Cheriyan & Edmund Y. Ko

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  1. Jim K. Shen
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  2. Salim K. Cheriyan
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  3. Edmund Y. Ko
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Correspondence to Jim K. Shen .

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  1. Liverpool Women's Hospital, Liverpool, United Kingdom

    Nabil Aziz

  2. Center for Reproductive Medicine, Cleveland Clinic, Cleveland, Ohio, USA

    Ashok Agarwal

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Shen, J.K., Cheriyan, S.K., Ko, E.Y. (2017). Ejaculatory Dysfunction: Retrograde Ejaculation. In: Aziz, N., Agarwal, A. (eds) The Diagnosis and Treatment of Male Infertility. Springer, Cham. https://doi.org/10.1007/978-3-319-56547-7_7

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  • DOI: https://doi.org/10.1007/978-3-319-56547-7_7

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