Anejaculation + Retrograde ejaculation
- Sympathetic nerve injury: RPLND, spinal cord injury (< 5% can ejaculate), colorectal/vascular surgery
- Bladder neck closure failure: TURP (other BOO procedures), diabetes
- Prostate cancer: hx surgery or radiation
- Medications: a-blockers, B-blockers, SSRIs, MAOis, TCAs, benzos, antipsychotics, Amicar (aminocaproic acid)
- Diagnosis: post-ejaculate urinalysis differentiates retrograde ejaculation (sperm present in urine) from anejaculation (sperm absent in urine)
a-agonists for retrograde ejaculation
- Dosing: pseudophedrine 60mg QD-QID or ER 120mg BID, imipramine 25mg BID, ephedrine 50mg QID
- Success: 58% diabetic men had antegrade ejaculation after 120mg QID day before and BID on day of intercourse
- Side effects: HTN, arrhythmias, urinary retention
- Contraindications: narrow angle glaucoma, HTN, CAD, CHF, arrhythmias, recent MI, urinary retention, DM, hyperthyroid, MAOi, hx seizures
Obtaining sperm in setting of anejaculation
- Retrograde ejaculation: urinary sperm retrieval/washing, success 20-50% per cycle
- Penile vibratory stimulation or electroejaculation: useful for MS, SCI, DM, or psychogenic causes, causes ejaculation 65-83% (PVS) and 80-97% (electro), electroejaculation requires general anesthesia, can induce autonomic dysreflexia
- Step-by-step video from Fertility & Sterility
References
- AUA Core Curriculum
- McMahon, C. "Disorders of Male Orgasm and Ejaculation." Campbell-Walsh Urology 12 (2020).
- Shindel, Alan W., et al. "Disorders of ejaculation: an AUA/SMSNA guideline." (2020).
- Wieder JA: Pocket Guide to Urology. Sixth Edition. J.Wieder Medical: Oakland, CA, 2021.