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On call: Back surgery and retrograde ejaculation

On call

Back surgery and retrograde ejaculation

Q. I am a 42-year-old former basketball player. Six months ago, I had a spinal fusion with the keyhole operation. My back pain is nearly gone and I feel great, but I've had dry ejaculations ever since the operation. Why does this happen?

A. The "keyhole" operation is the newest and least invasive way for doctors to stabilize the spine by fusing adjacent vertebrae. The operation requires only very small incisions. The surgeon inserts a fiber-optic laparoscope, which allows him to view the spine on a video monitor. Next, he inserts special instruments that enable him to correct the tissue damage. The operation requires special training as well as special equipment, but it allows a rapid recovery with few complications. Unfortunately, retrograde ejaculation is one of those complications. Men with the problem experience normal arousal, erections, and orgasm, but their semen travels back into the bladder instead of shooting out through the penis.

Diabetes is the most common cause of retrograde ejaculation. It is also a common complication of prostate surgery, occurring in 50%–75% of men who have the transurethral resection of the prostate (TURP) operation for benign prostatic hyperplasia (BPH). With the exception of alfuzosin (Uroxatral), the alpha blockers used to treat BPH medically can also cause the problem. And a study from Atlanta reported that 45% of men who had laparoscopic back surgery experienced retrograde ejaculation, probably because the surgery had damaged nerves that control the bladder neck. Whatever the cause, retrograde ejaculation develops because the muscles of the bladder neck fail to contract normally during orgasm, so semen flows into the bladder and no emission occurs. Most men still experience the pleasurable sensation of orgasm, but fertility is impaired.

Your condition may improve in time. If it doesn't and if fertility is an issue, you may be a candidate for one of the new assisted reproduction techniques.

Surgery succeeded in controlling your back pain, but it seems to have caused another problem. It's a reminder that no operation is truly "minor" when you are the patient.

— Harvey B. Simon, M.D. Editor, Harvard Men's Health Watch

Last updated:	September 05, 2008