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Retrograde ejaculation (a proposed accreditation method)

David Sanders and colleagues discuss laboratory assessment of samples for retrograde ejaculation and outline how accreditation could work.

Retrograde ejaculation occurs when semen enters the bladder instead of emerging from the penis during orgasm. There are several causes of retrograde ejaculation, including:

Surgery to the bladder neck, prostate or retroperitoneal lymph node

  • Some medication for the treatment of high blood pressure, depression or enlarged prostate gland may have side effects including an increased likelihood of retrograde ejaculation
  • Nerve damage due to a spinal cord injury or medical conditions affecting the nervous system
  • Congenital defects, such as utricular cysts.

Diagnosis is based on the absence of sperm in the antegrade ejaculate and the presence of sperm in post-masturbatory urine. Retrograde ejaculation may be suspected whenever the semen volume is significantly reduced, not present or intermittent.

Whilst retrograde ejaculation is relatively rare, it is important to distinguish it from the absence of ejaculate (aspermia) rather than just the absence of sperm (azoospermia). The treatment options for these are potentially different.

Compared with semen analysis for fertility assessments and post-vasectomy clearance, requests for examination of urine samples for spermatozoa as part of the investigation of retrograde ejaculation are very low. It is the small numbers of samples received by the diagnostic laboratory that deters laboratories adding the examination of urine for spermatozoa to their scope of accreditation.

The correct diagnosis of patients with retrograde ejaculation is important, potentially preventing a patient from having to undergo unnecessary surgical sperm retrieval. Therefore, any diagnostic test performed on these patients should be performed accurately and under the same levels of control as any other diagnostic test.

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Picture Credit | Science Photo Library

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