Digest of recent discussions on ISSM mail (Sept 2009 - Dec 2009)

XII

REYNALDO GOMEZ

Post-TUR Retrograde Ejaculation

December 20, 2009: 11 Messages

1

I have a 65 year old psychiatrist suffering RE (retrograde ejaculation) after a TUR (trans-urethral resection) for BPH (benign prostatic hyperplasia) in 2007. He states that nobody warned him about this expected side effect, is very upset, and wants to recover his antegrade ejaculation. Does anybody know about any useful medication/surgery?

                                                                                       Reynaldo Gomez (gomezycia@manquehue.net)

2

Imipramine 25-50 mg taken 2-4 hours before intercourse may help; plus sex with a full bladder, but the latter is less likely to be effective after TURP (trans-urethral resection of the prostate) than in RE with alpha-blocker.

Geoff Hackett (geoff.hackett@virgin.net)

3

RE is very common following TURP, in the range of 60-95%. Unfortunately, this is a permanent side effect when it happens. This should remind us to advise our patients about risks and benefits of any surgical procedure with a proper informed consent. Is the patient concerned about fertility?

Joseph Zadra (joezadra@rogers.com)

4

Why is he upset? I guess he has normal feelings of orgasm? Why does he need antegrade ejaculation? Is his male self image disturbed? Or is he angry because he wasn't warned and it is this that he needs attention to?

 Peter Leusink  (leusinkp@knmg.nl)

5

I`ve seen a patient (46 year old:  TURP 8 months) whose RE management was done elsewhere with experimental drug (`secret’, but similar to botox) applied  to the bladder neck. The ejaculate volume ranges from 0,9 to 1,1 ml: no urinary obstruction...and very happy.

 Claudio Teloken  (urologyteloken@yahoo.com)

6

Tofranil or amytryptylline may help at 25-50 mg once or twice per day to close off the bladder neck. He should have been told that this happens in over 90% of men.

 Jack Barkin  (j.barkin@rogers.com)

7

This is probably a permanent change. He might try taking Pseudofed 30 mg a few hours prior to sex, but if the bladder neck is too resected this is probably permanent. I don't think imipramine will be as effective.

                                                                                                                          Frederick Snoy (snoyfj2@aol.com)

8

I like the clear explanation by Neil Gordon and this should be translated to all lay languages in the informed consent to all patients undergoing TURP to avoid another sad man.

Kar Mun Verna Lee  (verna.lee69@gmail.com)

9

I have been following all the experts discussing this issue of absent ejaculation after TURP.
Actually, there is no effective therapy for this condition. Fortunately, since this procedure is done on older men who have completed their families, the issue of loss of fertility seems irrelevant in most cases.  However a dry ejaculate is associated with a peculiar feeling and even if the patient is counseled about it, it takes a while to get used to it. I have tried Tamsulosin for a few weeks and have experienced dry ejaculation as a consequence which is pretty awful. Stoppage of the drug returns the ejaculate. Also the feeling of ejaculation while on these drugs is altered. Since most of us have no personal experience, if the patients describe it, it is important for us to pay heed to the distress factor of these people who trade one complaint for another, as part of the treatment. There is no drug that can close a resected bladder neck other than bladder neck obstruction itself which will defeat the purpose of a good TURP. The only plausible therapy is sympathomimetic agents like ephedrine or pseudoephedrine or imipramine which have to be given in high doses and often do not work. Single bladder neck incisions may preserve the antegrade ejaculation in up to 40 % of patients. Bladder neck preserving advantages exist with TUNA, interstitial laser coagulation and thermotherapy.

                                                                                                                      T R Murali (golde2003@gmail.com)

10

If you need an alpha blocker for bladder outlet obstruction symptoms, I would suggest Uroxatral as it seems to not have the ejaculatory effects of the other alpha blockers.

 
                                                                                                               David Spellberg (ecsdms@hotmail.com)

11

I agree with Dr. T R Murali that this is a permanent change that the patient has to deal with. Informed consent is a must before TURP. I have experience with hundreds of TURP patients and there seems to be no medication that can treat this permanent RE.

 Ricky Adriansjah (ricky_adriansjahdr@yahoo.com)