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A case is described of retrograde ejaculation due to bladder neck resection followed by ileal conduit with a non-functioning bladder, where, after unsuccessful attempts at artificial insemination with spermatozoa retrieved from the bladder, ejaculate was obtained at defecation followed by artificial autoinsemination by the male, leading to two consecutive pregnancies.
Three patients with infertility secondary to retrograde ejaculation demonstrated motile sperm in their urine after coitus. These patients were instructed to alkalinize their urine and void directly into the vagina after intercourse. The technique was called "postcoital-voiding insemination." Three pregnancies have resulted. The technique appears to be a good alternative to bladder catheterization and artificial insemination.
Sperm quality influences fertility and offspring health through both genomic inheritance and epigenetic inheritance. Thus, for use in clinical-assisted reproductive technology (ART), spermatozoa must have optimal genomic and epigenetic structures. In patients with retrograde ejaculation, spermatozoa are usually recovered from urine and then cryopreserved for ART. However, the effects of urine exposure and subsequent freeze-thaw cycles on sperm quality remain unclear. This is particularly true for epigenetic changes and their underlying mechanisms. In this study, we examined how different durations of urine exposure (10 min and 40 min) followed by freeze-thaw cycles affected sperm motility, DNA integrity, and methylation levels of imprinting genes (H19-imprinted maternally expressed transcript [ H19 ], mesoderm-specific transcript [ MEST ], and the transposable element Alu [ Alu ]). As the duration of urine exposure increased, sperm motility (median [interquartile range]) decreased from 48.0% (39.0%-52.5%) to 1.0% (1.0%-5.0%), the DNA fragmentation index (DFI; median [interquartile range]) increased from 12.0% (9.3%-19.9%) to 23.5% (13.9%-33.9%), the MEST methylation level (mean ± standard deviation [s.d.]) increased from 3.8% ± 1.5% to 11.5 ± 1.2%, and the H19 methylation level (mean ± s.d.) decreased from 86.9% ± 0.9% to 82.1% ± 0.5%. The freeze-thaw process further reduced sperm motility, while the DFI and methylation levels of MEST and H19 did not significantly change. The Alu methylation level remained stable. These findings demonstrate that urine exposure affects sperm motility, DNA integrity, and methylation levels of some imprinting genes. These effects intensify over time. In contrast, the freeze-thaw process impacts only sperm motility. In clinical practice, minimizing exposure to urine might improve sperm quality.
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We reviewed the cases of fifty patients who underwent anterior lumbar-spine fusion with autogenous fibular and iliac-bone grafts and were followed for two to fifteen years. Their diagnoses were instability of the spine, degenerative disc disease, pseudarthrosis, and spondylolisthesis. Fifty-six per cent had union and 44 per cent, non-union. Those who had iliac grafts healed in an average of 2.5 years and those who had fibular grafts, in 5.2 years. The clinical result was successful in twenty-six patients (52 per cent) and unsuccessful in twenty-four patients (48 per cent). Paradoxically, about one-half of the patients with clinical successes had a non-union and one-half of the failures had union. Retrograde ejaculation (sterility) did not develop in any of the men, and a survey of world authorities on anterior spine fusion revealed only sixteen patients with the sequela of retrograde ejaculation. The incidence of that complication has been exaggerated.
The long-term treatment of retrograde ejaculation disorders following retroperitoneal lymphadenectomy with the alpha-sympathomimetic, Midodrin, administered orally, led to improvements in the intensity of orgasm and the degree of erection. Normal ejaculation was induced in 7 out of 12 patients and emission of spermatozoa into the posterior urethra was restored in 3 out of 12 patients by a single intravenous injection of 25--30 mg Midodrin.
200 bladder neck incisions in 172 patients with mechanical or functional outlet obstruction of neurogenic and nonneurogenic etiology are reported. The incision was performed with an electric cautery needle at 5--7--12 o'clock. Parameters of success were, beside the subjective reports, residual urine, urinary flow and a sophisticated urodynamic study. 71% of the women and 76% of the men showed improvement or relief of symptoms. Retrograde ejaculation was observed in only 7% of the men; the rate of complications was 2.5%. Despite limited experience and the lack of long-term follow-up, this technique is recommended for routine use.
Specific and effective medical treatment is available for some subfertile males. Reproductive physiology should be reviewed with all patients and exposure to drugs and toxins known to impair testicular or accessory sex gland function should be terminated. Appropriate treatment of retrograde ejaculation, chronic infections of the genital tract, or gonadotropin deficiency is indicated. Accurate diagnosis and treatment of the impotent patient may restore potency and fertility. Pregnancies have been achieved in association with each of the empirical regimens; however, we believe that each must be viewed as experimental at this time, since results may be no better than those observed in the absence of treatment. It is our experience that patients with elevated serum levels of FSH, peritubular fibrosis, and hyalinization are unlikely to achieve fertility regardless of treatment; however, there are exceptions. As our knowledge of basic reproductive biology and clinical pathology increases, it is hoped that better guidelines and more rational and effective medical treatment for the subfertile male will evolve.
Sexual dysfunction associated with diabetes mellitis has been reviewed. The prevalence of impotence among diabetic males ranges between 50 and 60 percent. Duration of diabetes does not correlate with the increasing incidence of impotence, but increasing age of the male is associated. The etiology of impotence is generally assumed to be autonomic neuropathy; the role of vascular pathology is moot. Retrograde ejaculation is present in one to two percent of the cases. Nocturnal penile tumescence monitoring during periods of rapid eye movement (REM) sleep will aid in the differential diagnosis of organic vs psychogenic etiology. Penile prostheses should be considered in the treatment of organic impotence, while sex counseling is indicated for psychogenic cases. The effect of diabetes on female sexual response is conflicting. Further research in needed.