Konstantinidis Charalampos, Zachariou Athanasios, Evgeni Evangelini, Çayan Selahittin, Boeri Luca, Agarwal Ashok
Urology & Neuro-Urology Unit, National Rehabilitation Center, 13122 Athens, Greece.
Andrology Unit, Urology Department, Ioannina University, 45500 Ioannina, Greece.
Diagnostics (Basel). 2025 Mar 14;15(6):726. doi: 10.3390/diagnostics15060726.
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.
逆行射精（RE）是一种精液向前排出受损的病症，会导致受影响个体出现不育和心理困扰。本叙述性综述探讨了逆行射精的病因、病理生理学、诊断和管理，强调其对男性生育能力的影响。逆行射精可能导致射精部分或完全缺失。逆行射精的原因包括解剖学、神经学、药理学和内分泌因素，常见诱因如糖尿病、脊髓损伤和前列腺手术。诊断主要涉及患者病史、射精后尿液样本的实验室分析以及先进的成像技术。逆行射精的管理策略包括药物干预、手术方法和辅助生殖技术（ART）。拟交感神经药和抗副交感神经药已取得一定成效，但受副作用和疗效差异的限制。辅助生殖技术，特别是从射精后尿液中获取精子的技术，为受孕提供了可行的替代方案，尿液碱化和先进的精子处理等技术显示出有前景的结果。尽管有这些进展，但治疗效果仍不一致，许多研究样本量小且缺乏有力的临床试验。未来的研究应专注于改进诊断工具、优化辅助生殖技术方案以及开发微创治疗方法。通过填补这些空白，医疗保健提供者可以改善逆行射精患者的生育结果和生活质量。
