Treatment Of Retrograde Ejaculation Research Articles

MP52-01 THE EFFECT OF BUSPIRONE ON REFRACTORY NEUROGENIC RETROGRADE EJACULATION TO PSEUDOEPHEDRINE

INTRODUCTION AND OBJECTIVES:The treatment of retrograde ejaculation (RE) is important not only for fertility but also for satisfaction of sexual intercourse. Ideally, the goal of treatment is to es...

Correction of Retrograde Ejaculation in Patients with Diabetes Mellitus Using Endourethral Collagen Injection: Preliminary Results.

Diabetic neuropathy secondary to diabetes mellitus type 1 (DM1) is responsible for retrograde ejaculation (RE) in 5-18% of cases. Medical treatment of RE is based either on increasing the sympathetic tone of the bladder or on decreasing the parasympathetic activity. However, the onset of side effects and the lack of response should be considered. The aim of this study was to analyze long-term outcome of endourethral injection of volume-forming material (VFM) of collagen type 2 into bladder neck submucosa in patients with RE secondary to DM1. Twenty-four patients with complete RE refractory to imipramine and DM1 were included in the study. Patients were single-blinded randomized according to a computer-generated random sequence with a 1:1 ratio in two treatment groups, namely group A (endourethral collage type 2 injection) and group B (endourethral saline water injection). New technique includes an endoscopic injection of VFM such as collagen (Correcting MIT®, Ltd. minimally invasive technologies, Moscow, Russia) into bladder neck submucosa. Primary endpoint of the study was the reduction of semen antegrade volume (mL). Secondary endpoints were considered as the changes of antegrade count (millions/mL), antegrade total motility (%), antegrade progressive motility (%), State-Trait Anxiety Inventory, Beck Depression Questionnaire and International Index of Erectile Function (IIEF-5). Pregnancy rate was calculated in each group. Twenty-three patients completed the study. In group A, significant differences from baseline to 12 months were observed relative to antegrade volume (mL) (mean difference: 0.71, P < 0.05), antegrade count (millions/mL) (mean difference: 45.6, P < 0.05), antegrade total motility (%) (mean difference: 15.4, P < 0.05) and antegrade progressive motility (%) (mean difference: 8.4, P < 0.05). In group A, we observed significant differences in terms State-Trait Anxiety Inventory (mean difference: -20.5, P < 0.05) and Beck Depression Inventory (mean difference: -8.4, P < 0.05) with significant differences compared with group B. We observed significant improvements in group A vs. group B when considering primary and secondary endpoints of the study, but not for the IIEF-5. Correction of RE in DM1 patients could be achieved with endourethral injection of collagen type 2.

AB140. The effectiveness and adverse effects of amoxapine for treatment of retrograde ejaculation

ObjectiveRetrograde ejaculation (RE) is an ejaculation disorder that can cause male infertility. It is defined as a pathological condition in which some or all semen is not emitted despite orgasm. The main cause of RE is believed to be decreased function of the bladder neck due to conditions such as diabetes, pelvic surgery, and drug resistance. Currently imipramine is the drug of choice for treatment of RE, but side effects such as drowsiness sometimes develop. In this controlled clinical study we evaluated the effectiveness and adverse effects of imipramine and amoxapine for treatment of RE.MethodsTwenty men were randomly assigned to one of two groups. We gave amoxapine to group I and imipramine to group II during the first 2-week period and examined adverse effects and semen volume. After a 1-week washout period, the drugs were switched for a second 2-week period. Mean age was 42.5 years (range, 30-52). Disease duration was 3 months to 5 years (average, 1.6 years). The main causes of RE were diabetes (n=13), surgery for rectal cancer (n=3), and retroperitoneal lymph node dissection for testicular cancer (n=1) (there is some overlapping); cause was unknown in 4 cases. Male infertility was the reason for consultation in 13 cases. The men were provided with a 2.5-cc syringe for self-measurement of semen volume during ejaculation.ResultsIn 9 cases, sperm was found in urine after orgasm. With amoxapine treatment, 17 (85.0%) men were able to ejaculate. Mild drowsiness was noted in 4 cases. With imipramine treatment, 13 (65.0%) men were able to ejaculate. Mild drowsiness was noted in 3 cases and severe drowsiness in 1 case. ED was observed in 5 patients, but erection hardness was greater than EHS3 after use of PDE5I. All men who reported semen emission with imipramine were also able to ejaculate while receiving amoxapine. Semen volume was significantly greater with amoxapine than with imipramine (P<0.001). The incidence of adverse effects was similar for amoxapine and imipramine. Amoxapine was effective for all men who had positive results with imipramine.ConclusionsIn the treatment of RE, amoxapine was much more effective than imipramine, and equally safe.

Diagnostic and treatment of retrograde ejaculation as a manifestation of urogenital form of autonomic diabetic polyneuropathy

Background. Retrograde ejaculation in patients with type 1 diabetes mellitus is a complication of autonomic neuropathy that causes excretory infertility. It can be partial (reduction of ejaculate) or total (absence of ejaculate) and occurs in 10%–20% of men with type 1 diabetes mellitus.Aim. The aim of the study was to assess the effectiveness of a new endoscopic method for retrograde ejaculation correction and antegrade ejaculation restoration.Materials and methods. We included 30 patients with type 1 diabetes mellitus who had spermatozoa present in their post-orgasmic urine and ultrasonographic evidence of impaired or absent bladder neck closure. The mean age of participants was 32 (30–35) years, mean duration of diabetes was 17 (12–22) years and mean preoperative glycated haemoglobin level was 7.4% (6.9%–8.0%). All participants had total retrograde ejaculation. We used conventional irrigated urethrocystoscopy under local anaesthesia. During urethroscopy, bladder neck gaping was observed in all cases. Biocompatible material was injected at three points under the mucous layer of the posterior urethra, reaching the closing of the opposite edges of the urethra. A spermiogram was examined 1 week after the operation.Results. Restoration of antegrade ejaculation was achieved for 22 patients (73%), and the effects persisted for a mean of 7 (2–12) months. The spouses of four men became pregnant after surgery. In one case, the pregnancy resulted in a spontaneous abortion at gestational week 8, but the other three cases continued normally.Conclusion.This new method provides a highly effective means of restoring the physiological passage of the ejaculate. The operation is a low-invasive endoscopic procedure that does not disrupt urination, and it is possible to receive ejaculate of sufficient.

Treatment of Retrograde Ejaculation in Paraplegia

Treatment of Retrograde Ejaculation in Paraplegia

Medical Treatment of Retrograde Ejaculation in Diabetic Patients: A Hope for Spontaneous Pregnancy

Retrograde ejaculation (RE) is one of the complications of diabetes mellitus. Different therapeutic approaches are present, whether medical or surgical, with limited success rates. The aim of the present study is to evaluate different drug regimens for the medical treatment of RE in diabetic patients. Thirty-three diabetic patients with RE (23 complete and 10 partial) were included in the study. Patients were given three sequential courses of medical treatment: imipramine 25 mg twice/day, pseudoephidrine 120 mg twice/day, or combination of the two drugs. Establishment of antegrade ejaculate in cases with complete RE and improvement of semen quality in case of partial RE. In cases with complete RE, imipramine was successful in producing antegrade ejaculate in 10 patients (38.5%), while pseudoephedrine was successful in 11 patients (47.8%), and both drugs given together was successful in 16 patients (61.5%). In cases with partial RE, there was significant increase in the antegrade semen sample as regards semen volume, sperm count, total, and progressive motility with imipramine alone, pseudoephidrine alone, and both drugs. From the present study we can conclude that medical treatment for RE in diabetic patients is a promising method and should be the first line of treatment in these cases.

Retrograde ejaculation: Etiology, diagnosis, and management

Retrograde ejaculation (RE) is a well-known cause of male factor infertility. Recognized causes of RE include previous genitourinary surgery involving the bladder neck, genitourinary trauma, neurologic conditions, and side effects from medications. Diagnosis of RE is generally based on thorough history, limited physical evaluation, and focused laboratory testing. A number of therapeutic approaches are available for the treatment of RE or RE-related infertility. The management goal of RE is either to induce spontaneous antegrade ejaculation or to provide sufficient quantities of motile sperm for use in assisted reproductive techniques. This article summarizes the etiology, evaluation, and management of RE.

Successful treatment of retrograde ejaculation with the α1-adrenergic agonist methoxamine: case study

We treated two patients affected by retrograde ejaculation (RE) with the pure alpha1-adrenergic agonist methoxamine; the drug was self-administered intramuscularly by the patients 30 min prior to intercourse or masturbation. A previous trial with oral imipramine had been ineffective in both patients. Sperm count increased substantially, particularly in the first patient who had insulin-dependent diabetes and was seeking fertility. In this patient, total ejaculated sperm increased from 22 millions to 488 and 419.5 millions on two different occasions, with good motility; two clinical pregnancies were obtained in the partner of this patient after 3 and 4 months of treatment, respectively. The second patient did not desire fertility. In both patients, no side effects were seen except for slight piloerection; blood pressure values increased slightly, and heart rate was unchanged. We conclude that self-administered methoxamine can be a useful, noninvasive and inexpensive treatment of RE, when oral agents are ineffective.

Retrograde ejaculation: etiology and treatment via the use of a new noninvasive method

Retrograde ejaculation (RE) is not a common infertility problem, but has increased in incidence recently due to surgical aggressiveness in pelvic and genital malignancies. However, RE is the most common cause of aspermia, or absence of ejaculate at orgasm. Meanwhile, surgical or drug therapy methods have not been very promising in regaining normal antegrade ejaculation. As yet, the standard procedures for treatment of RE involve the artificial insemination of either nonprocessed or processed (via centrifugation and resuspension) postcoital voided bladder contents. RE specimens in this study were collected after postcoital voiding into a TEST buffer and resuspended in TEST-yolk buffer. The urine effects on the voided spermatozoa were studied. The technique employed in this study assists in the recovery and reconstitution of RE fit for artificial insemination.

Treatment of retrograde ejaculation with imiprimine

We describe 2 cases of retrograde ejaculation in diabetic patients. Treatment with the alpha-adrenergic stimulator, imiprimine, resulted in reversal of seminal trajectory.

Medical Treatment of the Subfertile Male

Specific and effective medical treatment is available for some subfertile males. Reproductive physiology should be reviewed with all patients and exposure to drugs and toxins known to impair testicular or accessory sex gland function should be terminated. Appropriate treatment of retrograde ejaculation, chronic infections of the genital tract, or gonadotropin deficiency is indicated. Accurate diagnosis and treatment of the impotent patient may restore potency and fertility. Pregnancies have been achieved in association with each of the empirical regimens; however, we believe that each must be viewed as experimental at this time, since results may be no better than those observed in the absence of treatment. It is our experience that patients with elevated serum levels of FSH, peritubular fibrosis, and hyalinization are unlikely to achieve fertility regardless of treatment; however, there are exceptions. As our knowledge of basic reproductive biology and clinical pathology increases, it is hoped that better guidelines and more rational and effective medical treatment for the subfertile male will evolve.

Treatment of retrograde ejaculation with brompheniramine

The retrograde ejaculation experienced by a juvenile diabetic man was successfully treated with brompheniramine, a drug having antihistaminic and anticholinergic properties. A possible mechanism of action is suggested.