A mechanistic, imaging-based classification of complete retrograde ejaculation: insights from dynamic transrectal...

Area of Science:

• Urology
• Reproductive Medicine
• Diagnostic Imaging

Background:

• Complete retrograde ejaculation (CRE) lacks standardized classification based on pathophysiology.
• Current diagnostics cannot visualize dynamic bladder neck (BN) and external urethral sphincter (EUS) dysfunction during ejaculation.

Purpose of the Study:

• To characterize the ejaculatory process in CRE using dynamic transrectal ultrasound (TRUS).
• To establish an etiology-specific, mechanism-driven classification system for CRE.

Main Methods:

• Consecutive CRE patients (n=20) underwent real-time TRUS during stimulated ejaculation.
• Etiological subgroups included diabetes mellitus (n=10) and urethral stricture (n=10), with SCI subtype based on literature.
• Dynamic video analysis and quantitative comparison were performed.

Main Results:

• TRUS revealed three distinct functional phenotypes of CRE linked to specific etiologies.
• Coordination dysfunction (SCI): delayed BN closure, failed EUS relaxation.
• Incomplete closure (stricture): partial BN incompetence with high outflow resistance.
• Complete bladder neck failure (diabetes): absent BN contraction, immediate total reflux.

Conclusions:

• Dynamic TRUS visualizes ejaculatory mechanisms in CRE, enabling quantification and revealing distinct pathophysiology.
• A novel three-type classification (Coordination Dysfunction, Incomplete Closure, Complete Bladder Neck Failure) is proposed.
• This classification enhances diagnostic precision and supports personalized therapeutic strategies for ejaculatory dysfunction.