Retrograde Ejaculation – What Is It, and Why Does It Occur After BPH Treatment?
Retrograde ejaculation is the process by which semen does not exit the body via the penis but instead gets pushed back into the bladder during ejaculation. This is also known as a dry orgasm and can be caused by specific heat-based BPH treatments. Let’s talk about retrograde ejaculation in the context of BPH treatment, why it occurs, and if it should be a concern.
To understand more about retrograde ejaculation, it’s essential to define BPH. BPH is the benign enlargement of the prostate when prostatic cells proliferate uncontrolled. Because the prostate surrounds the urethra, the pressure from the excess tissue squeezes the urethra and causes lower urinary tract symptoms. Benign prosthetic hyperplasia is, of course, distinct from prostate cancer, which rarely manifests in urinary tract symptoms, especially in its earliest stages. BPH is almost ubiquitous, with upwards of 50% of men experiencing the signs by the age of 50 and 90% of men having symptoms by the age of 80.
Treating Prostate Issues Enlargement Issues
While Dr. Engel is a proponent of a stepwise treatment protocol for most urinary conditions, with the advent and refinement of modern BPH treatments, there is little reason to wait or use medication before choosing a procedural BPH option. Most commonly, for prostates under 80 g and with standard anatomy, Dr. Engel prefers a BPH procedure known as Rezum. Using a nerve block that he pioneered and ultimately mastered, patients are in and out of this procedure with very little pain and spend only a few minutes of their time. The results are long-lasting, with many patients seeing improvement even at 7 years.
For patients who may not achieve the results they expect with this therapy, Dr. Engel often recommends an outpatient hospital procedure known as bipolar TURP or transurethral resection of the prostate, which uses a bipolar electrical current to shave away excess prostatic tissue. Again, results are very predictable, and patients experience years of improvement before requiring a follow-up procedure.
For huge prostates, those over 80g, Dr. Engel performs a simple prostatectomy, which is a minimally invasive surgical procedure during which the pulp or adenoma of the prostate is removed, leaving only the outer sheath of the prostate. This is an exceptionally safe and effective procedure in the hands of an experienced urologic surgeon.
Retrograde Ejaculation
One of the considerations of any heat-based BPH procedure, however, is retrograde ejaculation. This is a virtual certainty after a bipolar TURP but occurs far less often in a minimally invasive Rezum procedure, where between 1 and 4% of patients will be affected. Retrograde ejaculation does not cause pain, erectile dysfunction, loss of sensation, or any sexual problems. Instead, some patients and their partners may be concerned about the lack of semen upon ejaculation.
Younger patients who are looking to have children will most certainly have fertility issues because of retrograde ejaculation. Knowing this, patient selection for a specific BPH procedure becomes very important. Fortunately, for most patients with BPH, having children is no longer a concern, and retrograde ejaculation does not factor into their decision over which procedure may be best for them.
For the less frequent cases of BPH in younger patients, a discussion should be had with Dr. Engel to understand the pros and cons of each BPH treatment and see what makes the most sense for their circumstances.
The Bottom Line
Most importantly, patients with BPH should know that they need not compromise because of lower urinary tract symptoms caused by BPH. Seeing a qualified urologist like Dr. Engel is a significant first step in understanding how to manage BPH and return to an enjoyable life without impediments.
