Penile pain, retrograde ejaculation

I am writing on behalf of my husband. He is 33 yr old and has several urology related problems that are causing problems for him and in our marriage. Prior to getting married 6 yr ago, I found my husb to be urinating frequently, sometimes 2-3 times per hour. I am a nurse and after we were married insisted he get evalauted. He was tested and told he had a congenital thickening of the bladded neck which was causing increased pressures in his bladder and difficulty in holding much urine. Similiar to BPH, but for him he had frequent urination for 15 yr he could remember.

They tried him on many different medications, most were BPH type meds, that either did not work or caused side effects he was not able to adapt to and continued working. He is also in healthcare. Since they rated his problem as significant and said it would most likely only worsen, they recommended surgery. He had this surgery done, they went in via the penis and sliced several sections of the thick neck of the bladder to make the bladder fill easier and fix his problem.

Prior to the surgery we were advised a small number of men have a post-op complication of retrograde ejaculation and if that happened it often was reversible. They wanted to make us awake if he did have that occur it would make conceiving difficult. I was pregnant of the time of the surgery, and he thought it best to proceed.

Well the surgery was a sucess and cured his problem of frequent urination. But he did have retorgrade ejaculation. This was not a temporary complication and he still has this problem...it has been 6 years. I have not used birth control since that time and nto gotton pregnant. We went back to the doctor to discuss our options re this, but were told nothing could be done; basially that the sperm were taking the "path of least resistance" which were back toward the bladder rather than through the urethra. We were told if we wanted to conceive, we would need to get infertility counseling.

First of all is this accurate? Is there no treatment fot this condition? We did seek a 2nd opinion.

Secondly, my husb has a severe sharp ,almost debilitating pain in the tip of his penis during the time he orgasms each and every time since this surgery. We have been back to the doctor about this and were once nothing could be done and another time he had a prostate infection. He was put on antiobiotics for 4 mo and had no improvment. All blood tests were normal. He was told his prostate was hard and inflamed and that he possibly had prostatis.

Are all of these things related? He never had anyof these problems prior to the surgery. We would just like to have a healthy sex life, but he never wants to have sex due to the severe pain he feels every time. Could this "prostate problem" be indirectly caused from the retrograde ejaculation? If so what can be done to stop the pain he is having (the ejacuation problem is not the major concern)? We would just like to have a normal sex life.

Thank you

[Kevin Pho, MD]

Hello - thanks for asking your question.

Without examining your husband, it is impossible to say if all the symptoms are related.

As you have mentioned, retrograde ejaculation is a complication of surgery to the bladder neck.  Some of the first treatments include medications such as pseudoephedrine or imipramine which improves the tone of the bladder neck.  

However, if the damage is too severe, then it may not be possible to restore normal ejaculation.  Infertility options include intrauterine insemination (using a small catheter to instill washed sperm inside the uterus at the time of ovulation); in-vitro fertilization (incubating eggs and sperm together in the laboratory to produce fertilization); or intracytoplasmic sperm injection (injecting a single sperm into the egg to cause fertilization).

Regarding the pain on ejaculation, I would first make sure that there is no anatomical abnormality causing the pain (i.e. urethral stricture or polyp).  If not already done, a cystoscopy can be considered for further evaluation.

Chronic prostatitis has already been considered and there has been a trial of several months of antibiotics.  A prostatic message, which subsequent evaluation of the prostatic fluid, should be done to make sure any infection is sensitive to the antibiotics.  Imaging of the prostate (i.e. via CT or ultrasound) can also be done to make sure that an abscess isn't present.  If so, antibiotics would not be able to treat a prostatic abscess.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

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