Sympathomimetic agents may be useful in the treatment of retrograde ejaculation. They act to stimulate the contraction of the bladder neck, prostate, seminal vesicles and vasa deferentia. Imipramine hydrochloride (75 mg bid), a tricyclic antidepressant that blocks norepinephrine reuptake at nerve terminal and potentiates peripheral adrenergic activity, may be the best agent to treat retrograde ejaculation in diabetic patients. Alpha-adrenergic sympathomimetic medications such as pseudoephedrine (60 mg four times daily), ephedrine or phenylpropanolamine enhance antegrade ejaculation. Alpha-adrenergic agents may aid in restoring closure of the bladder neck.
If medical therapy fails, sperm can be retrieved from post-coital urine samples and used for insemination. Poor results with these methods may be related to the acidic and hyperosmotic condition of the urine, and the effect on sperm function. Results can be improved by altering the composition of the urine. A common method involves consumption of sodium bicarbonate before ejaculation to alkalize the urine. In addition to the use of sodium bicarbonate, some physicians suggest monitoring and adjusting urine osmolarity to better mimic physiological conditions. Also, instructing the patient to void postejaculation urine in buffered media to decrease the detrimental effects of urine was found to be helpful.
In the case of anejaculation, penile vibratory or electroejaculation using an electrical probe can be successful and has been applied to the diabetic patient. Epididymal or testicular sperm aspiration and intracytoplasmic sperm injection can be applied when all else fails.
Category: Diabetes and male sexual function
Tags: Diabetes mellitus, Ejaculation, Erectile dysfunction, Sexual function, Sexuality