Visual real-time monitor ejaculatory-orgasm using transrectal ultrasound to identify the cause of Aspermia

Abstract Objective Aspermia is a common ejaculatory disorder having a feeling of orgasm,but no semen after masturbation or sex orgasm. Complete retrograde ejaculation is the common cause of aspermia The diagnosis of complete retrograde ejaculation is mainly determined by the presence of sperm after ejaculation in urine and no seminal fluid emerges from the penis at orgasm, we found it is not true by a visually real-time monitor ejaculatory-orgasm using transrectal ultrasound, this technique help us to exactly identify the cause of Aspermia and insights into the underlying mechanisms for Aspermia. Methods In a total of 11 cases of aspermia, with a large number sperms in the post-ejaculation urine, we have diagnosed these patients as retrograde ejaculation. we used transrectal real-time dynamic ultrasound to scrutinize the ejaculatory-orgasm process. To trigger ejaculation, audiovisual sexual stimulation was administered manually. During this procedure, we attentively observed and documented the alterations in the seminal vesicle, the neck of the bladder, the prostatic urethra, as well as the dynamic flow of semen, aiming for a comprehensive understanding of the ejaculatory-orgasm . Results Among the 11 cases, a mere 8 succeeded in completing the transrectal real-time dynamic monitoring of ejaculatory-orgasm. Of these, 6 cases exhibited distinctive signs of seminal vesicle contraction, posterior urethra dilation, bladder neck disclosure, and semen reversely flow into the bladder. The cause of these cases was retrograde ejaculation. In contrast, the remaining 2 cases displayed neither seminal vesicle contraction nor significant changes in the bladder neck, and no semen was found to flow backwards into the bladder. This suggested that the cause of these two cases was not retrograde ejaculation, but rather an emission disorder. According to our new technique we found that 2 cases diagnosis by the well-established diagnostic criteria,(the confirmation of retrograde ejaculation relies heavily on the presence of cloudy post-ejaculatory urine, and an abundant count of sperms in cases of aspermia) was misdiagnosis ,the aforesaid diagnostic criteria is not infallible, with an estimated misdiagnosis rate of approximately 25% in our cases. Conclusion Real-time dynamic transrectal ultrasound monitoring ejaculatory-orgasm is a novel and visually intuitive technique to explore potential cause behind ejaculation disorder .It provides valuable insights into the underlying mechanisms for aspermia .Moreover, We approved that not all cases of aspermia accompanied by a significant amount of sperm in post-ejaculation urine are attributed to complete retrograde ejaculation by this technique.