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retrograde ejaculation
Etiology:
1) benign prostatic hypertrophy [2]
2) surgical procedures
a) transurethral prostatectomy
b) lumbar sympathectomy
c) retroperitoneal lymph node dissection
3) peripheral neuropathy
a) diabetic neuropathy
b) spinal cord lesions
4) pharmaceutical agents
a) alpha-adrenergic receptor antagonists (alpha-blockers)
- selective alpha-1 blockers (tamsulosin, silodosin) implicated more than less selective agents
b) antipsychotic agents
Pathology:
- relaxing the bladder can cause semen to go backwards to the bladder during ejaculation
Clinical manifestations:
- absent or intermittent emission of semen, often as a part of an infertility evaluation
Laboratory:
- analysis of postmasturbation specimen for spermatozoa
Management:
- pharmaceutical agents with modest benefit
a) ephedrine
b) phenylpropanolamine
c) imipramine
General
ejaculatory dysfunction
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998
- Geriatric Review Syllabus, 7th edition
Parada JT et al (eds)
American Geriatrics Society, 2010