Retrograde ejaculationN50.88

Instead of the physiological antegrade ejaculation of the sperm from the urethra, there is a complete or partial retrograde ejaculation of the sperm into the bladder.

Causes can be malformations, inflammations, tumours or surgical interventions on the bladder neck, more rarely also drugs (such as phenoxybenzamine e.g. dibenzyran and other alpha-sympatholytics e.g. Minipress) or diabetes mellitus.

Partially retrograde ejaculation results in reduced ejaculate volume (less than 2 ml), reduced sperm motility and greatly reduced ejaculate fructose values (significantly less than 120 mg/dl, partly not measurable); completely retrograde ejaculation results in absence of ejaculate despite orgasm; spermatozoa are then detected in the urine or urine sediment.

Exclusion of malformations, inflammations or tumours. Stop all drugs that can cause retrograde ejaculation.

In the case of infertility symphatikomimetics such as Midodrin (e.g. Gutron) 10-40 mg i.v. or Imipramine (e.g. Tofranil) 3 times 25 mg p.o. Good success with Ameziniummetilsulfat (e.g. Regulton) once/day 10 mg p.o. have been described (off-label use; evidence level IV). Cave! Sympathomimetic side effects, especially in older patients.