Backflow of Ejactulation into Bladder

I recently started dating a gentleman who had testicular cancer 10 years ago.  His treatment included surgerical removal of lymph nodes as well as radiation and chemotherapy.  During a recent conversation, he indicated that he is sterile and does not ejactulate out of his penis, but backfills into his bladder.  Why is this so?  Can this be corrected?  Can someone explain this to me?  Also, is this painful?  Thank you.

[hfhs M.D.-AK]

Dear Reina,
The correct term for this complication after surgery is known as retrograde ejaculation.  After a retroperitoneal lymph node dissection, the risk of disrupting the sympathetic nerve fibers that coarse over and around the aorta are increased in serious cases of testicular cancer.  In modern surgical series, the risk of retrograde ejaculation has dropped significantly from 10-20 years ago.  Today, there is only about a 2-5% risk of this complication.  
The reason for this clinical outcome stems from the function of the sympathetic nerve fibers.  These nerves are responsible for closing the bladder neck during forceful ejaculation.  The flow of the semen in the prostate gland can go in two directions.  It tends to proceed in the path of least resistance.  If the bladder neck is not closed, the semen simply is deposited into the bladder with the urine.  If the bladder neck is closed, it is ejaculated out of the penis.  Without a post ejaculatory urinalysis, it is difficult to comment on the presence of sperm or the function of these sperm.  Retrograde ejaculation, does not necessarily make an individual sterile.  The sperm in patients with retrograde ejaculation are often viable and can be used with outside fertility help to conceive a child.  To find out if the sperm are healthy, an infertility work-up would be necessary.  The radiation, and chemo may however have caused him to be sterile, but semen may still be present.
The next step if he is interested, would be to consult a urologist for fertility testing and possible correction of this condition.  With the limited history you have provided, it is difficult to make further comments.
This information is provided for general medical educational purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.  More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).


Sincerely,
HFHS M.D.-AK
*keyword:Retrograde ejaculation

[Pat]

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[Reg]

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[liz sharp]

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[Joe]

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