Retrograde ejaculation
As retrograde ejaculation a is ejaculation disorder referred to, wherein the seminal fluid backwards in the bladder is discharged. This can appear as a delayed, weakened or absent (visible) ejaculation and in the latter case also simulate azoospermia .
causes
The causes usually arise as a result of neurological or anatomical changes after certain medical treatments ( iatrogenic ). These can cause malfunctions or a complete loss of function of the internal bladder sphincter . However, this can also occur in old age as a result of an enlarged prostate. If the urinary bladder is not properly closed at its exit, the seminal fluid takes the much shorter way up into the bladder instead of the long way out through the urethra (penis) because of the lower resistance.
Iatrogenic causes
This can be a side effect of drug therapy ( methyldopa ; alpha blockers such as phenoxybenzamine to improve urinary flow in the case of enlarged prostate (BPH)) and the like. a.), after transurethral resections of the prostate (in approx. 65% of those operated on) and operations in the pelvis and damage to the corresponding nerves. Retrograde ejaculation can also occur in mental disorders such as neurolepsy . Many patients suffer from it, so precise information from the attending physician is very important.
Acquired causes
Urethral stenoses of various causes and neurogenic damage as a long-term consequence of diabetes in multiple sclerosis and paraplegic syndrome are the most common acquired reasons for retrograde ejaculation.
Congenital causes
Malformations of the neck of the bladder , sympathetic disorders
diagnosis
The ejaculation volume is less than 1 ml. Retrograde ejaculation is confirmed by examining the urine microscopically for sperm , usually after masturbation .
therapy
Electrostimulation can show good results, especially in paraplegic patients . In the case of disorders due to long-term consequences of diabetes, drug treatment is also possible, for example with imipramine .
