BLADDER NECK COLLAGEN INJECTION RESTORES ANTEGRADE EJACULATION AFTER BLADDER NECK SURGERY

Abstract

A 36-year-old man with a history of Y-V plasty of the bladder neck during childhood presented with primary infertility and low volume ejaculate. Physical examination was normal. Semen analyses consistently demonstrated a diminished ejaculate volume, as well as impaired sperm density and motility (see table). Post-ejaculate urine specimens contained large numbers of sperm, indicative of retrograde ejaculation. Initially, oral pseudoephedrine was prescribed for 4 weeks without any improvement in ejaculate volume. Subsequently, 2 cycles of intrauterine insemination using sperm recovered from bladder washes were unsuccessful. After a nonreactive skin test 7.5 cc collagen were injected submucosally and circumferentially at the bladder neck. Although initial postoperative semen analyses showed increased volumes and counts, the couple elected intrauterine insemination. Intrauterine insemination with an antegrade ejaculate 3 weeks postoperatively resulted in a pregnancy, which ended in a first trimester miscarriage. Collagen injection was repeated in identical fashion 6 months later because of decreasing semen volumes. Within 1 month postoperatively pregnancy was achieved using an antegrade ejaculate with intrauterine insemination. At the time of this report, gestation is progressing normally at 4 months. The patient had no difficulty with urination and examination of