Retrograde ejaculation: Treatment

Content Written By: Wayne J. Hellstrom, MD and Mathew Oommen

Treatment of RE can be aimed either at simply restoring antegrade ejaculation or allowing for fertility and reproduction. Restoring antegrade ejaculation focuses on increasing sympathetic tone of the bladder neck or decreasing parasympathetic activity. If successful, the return of antegrade ejaculation may be sufficient to allow for natural conception or may provide enough good quality sperm to use with assisted reproductive techniques. Imipramine, given as a daily dose of 25-50 mg for seven days prior to planned intercourse, has been successfully used to treat RE, with a return of antegrade ejaculation in 65-100% of patients and a 40% rate of spontaneous pregnancy. Anticholinergics, alpha-adrenergic agonists, or similar combinations may be used to modulate bladder neck activity but are not as effective as imipramine, which should be considered the first-line therapeutic agent for RE.

SPERM RECOVERY

If medical management fails to return antegrade ejaculation, then attempts can be made to harvest sperm from urine for later use with ART. Since the acidity and high osmolarity or urine is detrimental to spermatozoa motility and viability, two different techniques are commonly employed to adjust the urine within the bladder. The first involves drainage of the bladder by urethral catheter and instillation of isotonic buffer solution that will prevent damage to the sperm. The patient masturbates, and then voids to recover sperm. A less invasive method involves alkalinization of the urine by drinking sodium bicarbonate solutions until the urine has a pH of 7.68.1 and an osmolarity of 300-500 mOsm/l. Once again, the patient masturbates and the urine is collected for sperm harvesting.

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