Restoration of antegrade ejaculation after transurethral bladder neck injection of Deflux for retrograde ejaculation: a case report of natural conception

Abstract

Retrograde ejaculation contributes to male infertility. Pharmacotherapy has a limited role in retrograde ejaculation. Deflux, a viscous substance, consists of two components: dextranomer microspheres and stabilized hyaluronic acid for the treatment of children with vesicoureteral reflux. According to the published articles, the authors described the first case achieved not only restoration of antegrade ejaculation but also followed conception of the spouse after transurethral bladder neck injection of Deflux. A 30-yearold male kept infertile after 3 years of marriage. The patient reported that he could not ejaculate in an antegrade direction after puberty when he reached sexual climax. There was no semen expulsed from the urethral meatus. Medicine prescribed by a local hospital didn't restore normal ejaculation. Four embryos fertilized by intracytoplasmic sperm injection developed well until transplantation, but none survived. The local reproductive center confirmed that his spouse preserved full capacity of fertility. He was diagnosed as retrograde ejaculation by real-time monitoring of transrectal ultrasound. He received transurethral bladder neck injection of Deflux. One month later, the patient restored antegrade ejaculation and the spouse of the patient conceived. During 18 months of follow-up, no related complications of the surgery have been observed. Transurethral bladder neck injection of Deflux can be considered as an alternative treatment method for retrograde ejaculation, and natural conception is possible thereafter.

Fertility Challenges: The Complexities of Retrograde Ejaculation and Cornual Block in Reproductive Health

“…Understanding the standard mechanism of ejaculation is crucial to comprehending the deviations that lead to conditions like RE. The coordination between the sympathetic and parasympathetic nervous systems and the involvement of various anatomical structures, such as the prostate, seminal vesicles, and bladder neck, is essential for successful ejaculation [ 11 ]. Disruptions in this intricate coordination can result in infertility.…”

The erectile and ejaculatory implications of the surgical management of rectal cancer

“…89 Additionally, there has been success in restoring antegrade ejaculation in patients by injecting Deflux, a gel composed of dextranomer and hyaluronic acid typically used to treat vesicoureteral reflux in pediatric patients, into the transurethral bladder neck. 90,91 Intrauterine insemination, in vitro fertilization, and intracytoplasmic sperm injection have also proven to be successful in the treatment of retrograde ejaculation. 92 To aid in this process, urinary sperm retrieval can be done by first emptying and washing the bladder with Ringer's lactate or sperm wash medium using catheterization.…”

“…Namely, retrograde ejaculation can be treated using sodium bicarbonate, sodium citrate, or potassium bicarbonate, as the acidity and osmolarity of urine has toxic effects on sperm 89 . Additionally, there has been success in restoring antegrade ejaculation in patients by injecting Deflux, a gel composed of dextranomer and hyaluronic acid typically used to treat vesicoureteral reflux in pediatric patients, into the transurethral bladder neck 90,91 . Intrauterine insemination, in vitro fertilization, and intracytoplasmic sperm injection have also proven to be successful in the treatment of retrograde ejaculation 92 .…”