Rigi10™ Malleable Penile Prosthesis
Also Known As
Ejaculation retrograde, Dry orgasm, Retrograde emission, Aspermia (when complete), Bladder ejaculation, Ejaculatio retrograda
Definition
Retrograde ejaculation is a condition in which semen enters the bladder instead of being expelled through the urethra during ejaculation.1 During normal ejaculation, the bladder neck muscle tightens to prevent semen from entering the bladder as it passes from the prostate into the urethra.2 In retrograde ejaculation, this bladder neck muscle doesn’t tighten properly, causing sperm to travel backward into the bladder rather than forward through the penis.3 The condition results in reduced or absent ejaculate volume despite normal orgasmic sensation, often referred to as a “dry orgasm.”4 While retrograde ejaculation isn’t harmful to physical health, it can significantly impact fertility and cause psychological distress in affected individuals.5
Clinical Context
Retrograde ejaculation is primarily diagnosed in the context of male infertility evaluations, contributing to approximately 0.3-2% of male infertility cases.1 The condition is diagnosed through patient history, physical examination, and laboratory analysis of post-ejaculatory urine samples, with the presence of 10-15 sperm per high-power field confirming the diagnosis.2
Patient selection for treatment depends on the underlying cause, which may include anatomical factors (e.g., prostate surgery, bladder neck surgery), neurological conditions (e.g., diabetes mellitus, multiple sclerosis, spinal cord injuries), or medication side effects (e.g., alpha-blockers, antidepressants).3 Treatment approaches vary based on etiology and fertility goals.
For patients seeking fertility, management options include pharmacological interventions using sympathomimetics (e.g., pseudoephedrine, ephedrine) and antimuscarinics (e.g., imipramine) to improve bladder neck closure during ejaculation.4 When medication is ineffective, assisted reproductive technologies utilizing sperm retrieved from post-ejaculatory urine samples can be employed, including intrauterine insemination or in vitro fertilization.5
Expected outcomes vary based on the underlying cause and treatment approach. Pharmacological treatments show efficacy rates of approximately 28% for sympathomimetics alone and 39% for combination therapy with antimuscarinics.2 Sperm retrieval from post-ejaculatory urine for assisted reproduction has demonstrated promising results, with pregnancy rates comparable to those achieved with normal ejaculate when appropriate sperm processing techniques are employed.5