Surgical therapy of retrograde ejaculation

Surgical therapy of retrograde ejaculation represents surgical techniques used in the treatment of retrograde ejaculation. Retrograde ejaculation (RE) is defined as a substantial redirection of seminal fluid from the posterior urethra into the bladder (Pic. 1) and mainly caused by bladder neck dysfunction. Men suffering from RE present with total or sometimes partial absence of semen, despite the sensation of an orgasm, after intercourse or masturbation.

Current treatment methods are based on two different strategies. 

1. The first is pharmacologic intervention or surgical management in order to restore antegrade ejaculation (ejaculation in the “healthy” direction) by increasing bladder neck tone. 
2. The second is urinary sperm retrieval or electroejaculation; this aims to facilitate fertility by obtaining spermatozoa with invasive methods and then applying artificial reproductive technologies. 

The treatment of retrograde ejaculation is based on underlying aetiology. Anatomical causes, for instance, after prostate surgery, are rarely curable, and sperm harvesting from the urine should be considered if pregnancy is desired. Surgery rarely is the first option for retrograde ejaculation and the results have proven to be inconsistent. 

Surgery is usually used only when medical treatment of the condition has failed, therefore, its success rate is not sufficiently documented. The outcome depends on the cause of the condition and the severity of damage. It has been reported to be successful in the majority of cases when the retrograde ejaculation was caused by previous bladder neck surgery. However, these reports are scarce.

Surgery involving the urinary bladder, such as in this case carries the risk of potential damage to the ureters or to the pelvic floor.

Successful surgical correction of retrograde ejaculation is capable of completely restoring the patient’s fertility. If a couple is experiencing infertility as a result of retrograde ejaculation and the treatment has not been successful, the male's ejaculate may be centrifuged and the isolated sperm injected directly into the woman through the use of intrauterine insemination (IUI). In more severe cases, in-vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) may be used.