LAUSR

OBJECTIVE 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 post-orgasm seminal vesicle volume and the presence of sperm in mid-stream urine, in patients with moderate-to-severe lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement. MATERIALS AND METHODS 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 (MSF-4 Q4) and the Male Sexual Health Questionnaire for Ejaculatory Dysfunction Short Form (MSHQ-EjD-SF). After 12 weeks, post-orgasm urine was collected for sperm count and seminal vesicle volume was calculated through trans rectal ultrasound. RESULTS All 42 patients reported with EjD after treatment with α1A-blockers: MSF-4 Q4 and MSHQ-EjD-SF Q4 scores were significantly higher (p < 0.001) and MSHQ-EjD-SF Q1-3 score was significantly lower (p < 0.001) than before. Post-orgasm seminal vesicle volume was significantly higher in patients with post-orgasm sperm-negative urine (AEj), and lower in patients with post-orgasm sperm-positive urine (REj; p < 0.001). CONCLUSIONS We clearly demonstrated an association between the presence of sperm in the mid-stream 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.