Etiology

Owing to a congenital or acquired anatomical and/or functional failure of closure of the internal sphincter of the bladder ("bladderneck") during the ejaculatory process, sperm passes into the bladder. Most frequently the cause is a transure-thral prostatectomy, a surgical treatment of benign prostatic hypertrophy. But any traumatic, neurogenic or drug-induced interference with the thoracolumbar sympathetic nervous system may lead to retrograde ejaculation. Spinal cord injury through trauma, birth defect, neoplasm, or surgery and abdominopelvic surgery, retroperitoneal lymph node dissection or total lymphadenectomy, and diabetes may also result in retrograde flow of semen.

The medications that may give rise to retrograde ejaculation include alpha-adrenergic blockers (e.g., prazosin, tamsulosin), peripheral sympatholytics (e.g., guanethidine), and antipsychotics (e.g., thioridazine).

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