Androlog Mail:
Colleagues,
I have recently seen a 40 year old man who had an uneventful vasectomy about
3years ago after 2 children. About a year later he began experiencing
increasingly severe searing pain in the distal penis just before and
throughout ejaculation. Typically the pain diminished over several hours
only to occur again with sexual activity either intercourse or masturbation.
He denied any scrotal pain, difficulty urinating, hematospermia, hematuria,
or any neurologic symptoms. He is not a diabetic and claimed his ejaculate
seemed normal to him. About a year ago he had unroofing of the ejaculatory
ducts by the urologist who referred him to me. After that procedure he
began having retrograde ejaculation and the typical pain persisted. His
retrograde ejaculation test did not yield sperm but did contain semen.
About 8 months ago I did a bilateral chromatovasogram demonstrating
excellent flow from the right ejaculatory duct but suspected reduced flow
from the left. The previous unroofing had been quite extensive with obvious
bladder neck resection and undermining of the bladder neck. I gingerly open
widely the left ejaculatory duct. The right duct remained untouched.
Postoperatively he remained as symptomatic as preoperatively. One month ago I
repeated his vasogram. They are wide open. He has had two "normal"
prostate ultrasounds and an unremarkable pelvic CAT. His physical exam has
remained unremarkable including the neurologic exam. He is a solid citizen
in a stable marriage. His attempts at any sexual activity are now stopped
by the pain. I would greatly appreciate any thoughts about this man's
condition and any ideas about management.
Eugene F. Fuchs, MD
Professor/Urology
Oregon Health Sciences University
Portland OR
fuchsef@aol.com
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