Department of Surgical, Oncological and Oral Sciences, Section of Urology, University of Palermo, Palermo, Italy.
Department of Surgical, Oncological and Oral Sciences, Section of Urology, University of Palermo, Palermo, Italy.
Urology. 2020 May;139:129-133. doi: 10.1016/j.urology.2020.01.027. Epub 2020 Feb 4.
To investigate the physiopathology of ejaculatory disorders (EjD) and discriminate between retrograde ejaculation (REj) and anejaculation (AEj) induced by α1A-blockers, through the association between the mean postorgasm seminal vesicle volume and the presence of sperm in midstream urine, in patients with moderate-to-severe lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement.
Therapy-naïve male patients with LUTS and without previous EjD were treated with α1A-blockers. Pre- and post-treatment EjD were investigated through question 4 of the 4-item Male Sexual Function questionnaire and the Male Sexual Health Questionnaire for Ejaculatory Dysfunction Short Form (MSHQ-EjD-SF). After 12 weeks, postorgasm urine was collected for sperm count and seminal vesicle volume was calculated through transrectal ultrasound.
All 42 patients reported with EjD after treatment with α1A-blockers: 4-item Male Sexual Function questionnaire and MSHQ-EjD-SF Q4 scores were significantly higher (P <.001) and MSHQ-EjD-SF Q1-3 score was significantly lower (P <.001) than before. Postorgasm seminal vesicle volume was significantly higher in patients with postorgasm sperm-negative urine (AEj), and lower in patients with postorgasm sperm-positive urine (REj; P <.001).
We clearly demonstrated an association between the presence of sperm in the midstream urine and seminal vesicle volume after orgasm, strongly confirming and differentiating the hypothesis of a dual etiology for EjD (REj vs AEj) secondary to α1A-blockers therapy for LUTS.
通过研究射精障碍（EjD）的病理生理学，并将其与α1A 阻滞剂引起的逆行射精（REj）和非射精（AEj）区分开来，探讨良性前列腺增生引起的中度至重度下尿路症状（LUTS）患者射精后精囊体积平均值与中段尿中精子存在之间的关系。
对未经治疗的 LUTS 且无 EjD 病史的男性患者使用α1A 阻滞剂进行治疗。通过 4 项男性性功能问卷第 4 项和男性性健康问卷射精功能障碍简短版（MSHQ-EjD-SF）第 Q4 项来调查治疗前后 EjD 的情况。治疗 12 周后，收集射精后尿液进行精子计数，并通过经直肠超声计算精囊体积。
所有 42 例患者在使用α1A 阻滞剂治疗后均出现 EjD：4 项男性性功能问卷和 MSHQ-EjD-SF Q4 评分明显升高（P<0.001），MSHQ-EjD-SF Q1-3 评分明显降低（P<0.001）。射精后精液中无精子的患者（AEj）的精囊体积明显较高，而射精后精液中有精子的患者（REj）的精囊体积明显较低（P<0.001）。
我们明确证明了射精后尿液中精子存在与精囊体积之间的相关性，这有力地证实并区分了α1A 阻滞剂治疗 LUTS 继发 EjD（REj 与 AEj）的双重病因假说。
