Recent Advances in the Diagnosis and Management of Retrograde Ejaculation: A Narrative Review.

Abstract

Retrograde ejaculation (RE) is a condition where the forward expulsion of seminal fluid is impaired, leading to infertility and psychological distress in affected individuals. This narrative review examines the etiology, pathophysiology, diagnosis, and management of RE, emphasizing its impact on male fertility. RE may result in the partial or complete absence of the ejaculate. Causes of RE include anatomical, neurological, pharmacological, and endocrine factors, with common triggers such as diabetes, spinal cord injury, and prostate surgery. Diagnosis primarily involves the patient history, a laboratory analysis of post-ejaculatory urine samples, and advanced imaging techniques. Management strategies for RE include pharmacological interventions, surgical approaches, and assisted reproductive technologies (ARTs). Sympathomimetic and parasympatholytic agents have demonstrated some success but are limited by side effects and variability in outcomes. ARTs, particularly with sperm retrieved from post-ejaculatory urine, offer a viable alternative for conception, with techniques such as urine alkalization and advanced sperm processing showing promising results. Despite these advancements, treatment efficacy remains inconsistent, with many studies relying on small sample sizes and lacking robust clinical trials. Future research should focus on refining diagnostic tools, optimizing ART protocols, and developing minimally invasive treatments. By addressing these gaps, healthcare providers can improve fertility outcomes and the quality of life for patients with RE.