Retrograde Ejaculation after RPLND

Posted By Doug Bank on August 02, 1998 at 01:29:42:







This message is primarily aimed at Dr JJ. In a previous message, he wrote "Although an artificial ejaculation can be induced via techniques of electro-ejaculation for purposes of semen collection for pregnancy, I am not aware of any treatment options that would offer relief of this specific problem."
In my response to the original post, I mentioned that sudafed was one over the counter medicine that might do the job. I was not joking. There are other medicines that have shown activity in solving this problem, and they are discussed in the Literature.
First of all, here is a quick URL that covers the topic:
http://www.medicinenet.com/Answr/retroe1.htm
Second, here are a few medline abstracts that are appropriate:
(While not listed, you might want to check out the Mar 1998 edition of Urology for more info....
Eur Urol 1994;25(3):226-228
Retrograde ejaculation and loss of emission: possibilities of conservative treatment.
Gilja I, Parazajder J, Radej M, Cvitkovic P, Kovacic M Department of Urology, General Hospital (Sveti Duh), Zagreb, Croatia.
Twenty-five patients with retrograde ejaculation/loss of emission were treated with ephedrine sulfate or imipramine hydrochloride. Seventeen of them suffering from both diabetes and retrograde ejaculation were treated with ephedrine or, in case that ephedrine failed to convert retrograde ejaculation into anterograde ejaculation, with imipramine. Positive results were obtained in 5/17 (29.3%) patients, i.e. in 3 (17.6%) and 2 (11.7%) patients on ephedrine and imipramine, respectively. The daily dose of ephedrine was 50 mg and that of imipramine 75 mg, during a 4-week period. In the group with retroperitoneal lymphadenectomy, after treatment with ephedrine, only 1 (12.5%) had retrograde ejaculation while the remaining patients (n = 7) continued to lack semen emission. These 7 patients were treated with imipramine, and 3 of them (42.8%) achieved anterograde ejaculation. In one third of patients with retroperitoneal lymphadenectomy and diabetes, with retrograde ejaculation or loss of semen emission, conservative treatment can offer improvement or conversion to anterograde ejaculation.

Eur Urol 1979;5(3):184-187
The use of Midodrin in the treatment of ejaculation disorders following retroperitoneal lymphadenectomy.
Jonas D, Linzbach P, Weber W
The long-term treatment of retrograde ejaculation disorders following retroperitoneal lymphadenectomy with the alpha-sympathomimetic, Midodrin, administered orally, led to improvements in the intensity of orgasm and the degre e of erection. Normal ejaculation was induced in 7 out of 12 patients and emission of spermatozoa into the posterior urethra was restored in 3 out of 12 patients by a single intravenous injection of 25--30 mg Midodrin.  

Urology 1979 Apr;13(4):414-415
Imipramine for aspermia after lymphadenectomy.
Kelly ME, Needle MA
During radical retroperitoneal lymphadenectomy the hypogastric sympathetic plexus is necessarily partially sacrificed, with resultant failure of part of the ejaculatory mechanism and aspermia. We have observed this condition to be reversible with imipramine.
Thanks for all the good work.
Doug Bank
Editor, Testicular Cancer Resource Center



Testicular Cancer Resource Center