Urethral Injury: Impotence and Ejaculation Issues After Trauma - Urology

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Urethral injury resulting in inability to ejaculate?


Hello Dr.
Lin, I am a patient who suffered a urethral rupture due to a car accident.
For the past two years, I have been troubled not only by urethral stricture but also by the inability to achieve erection and ejaculation, which is quite distressing for me.
As the only son, I bear the responsibility of carrying on the family lineage, so I would like to ask you, Dr.
Lin, I have heard that for patients like me, erectile dysfunction can also be a sequela in addition to urethral stricture.
What kind of treatment should I pursue? Additionally, I have experienced orgasm during masturbation without an erection, but there was no ejaculation.
When I applied pressure to the area behind the testicles, I noticed some blood flow, and I am unsure whether this is a sign of hematospermia or bleeding from a wound in the urethra.
If ejaculation does not occur, could it have any adverse effects on my health?

A Hong, 20~29 year old female. Ask Date: 2004/05/31

Dr. Lin Hexing reply Urology


Hello Blmeblur: A rupture of the urethra that does not involve injury to the penile corpora cavernosa may not necessarily lead to erectile dysfunction.
However, since you are experiencing such an issue, it is important to distinguish whether it is organic or psychological in nature.
First, do you have erectile dysfunction? Your description does not confirm whether you are completely unable to achieve an erection.
I wonder if you still experience erections upon waking in the morning.
I recommend that you visit a urology department at a medical center for a thorough examination to facilitate better treatment.
Regarding the issue of anejaculation, it is closely related to whether your urethral stricture has been adequately treated.
If the urethral stricture is severe enough to make urination difficult, it would also hinder ejaculation, causing the semen to be redirected into the bladder.
This does not pose a health risk, but the primary focus should be on treating the urethral stricture.

Reply Date: 2004/05/31

More Info


Urethral injuries, particularly those resulting from trauma such as car accidents, can lead to a variety of complications, including urethral stricture, erectile dysfunction, and ejaculation issues. Your concerns about impotence and ejaculation difficulties are valid and warrant a thorough understanding of the underlying mechanisms and potential treatment options.


Understanding Urethral Injury and Its Complications
1. Urethral Stricture: After trauma, the urethra can become narrowed due to scar tissue formation. This stricture can lead to urinary difficulties, including a weak urine stream, pain during urination, and urinary retention. Treatment often involves urethral dilation or surgical intervention to remove the stricture.

2. Erectile Dysfunction (ED): The relationship between urethral injuries and erectile dysfunction is complex. Trauma can affect the blood vessels and nerves that are crucial for achieving and maintaining an erection. Additionally, psychological factors such as anxiety about sexual performance after an injury can also contribute to ED.
3. Ejaculation Issues: The inability to ejaculate, despite experiencing orgasm, can occur due to nerve damage or disruption of the normal pathways involved in ejaculation. This condition is known as "dry orgasm." In some cases, the ejaculatory duct may be affected, leading to retrograde ejaculation, where semen enters the bladder instead of exiting through the urethra.

4. Blood in Semen: The presence of blood when you apply pressure to the perineum could indicate several issues. It may be related to blood vessels that have been damaged during the injury or could signify bleeding from the urethra itself. This condition, known as hematospermia, can be alarming and should be evaluated by a healthcare professional.


Treatment Options
1. Urethral Stricture Management: If you are experiencing significant urinary symptoms, it is crucial to consult a urologist who specializes in urethral injuries. They may recommend procedures such as:
- Urethral dilation: A non-surgical method to widen the urethra.

- Urethroplasty: A surgical procedure to reconstruct the urethra, particularly if the stricture is severe.

2. Erectile Dysfunction Treatment: Addressing erectile dysfunction may involve:
- Medications: Phosphodiesterase type 5 inhibitors (like Viagra or Cialis) can help improve blood flow to the penis.

- Psychosexual therapy: Counseling may help address any psychological barriers to sexual function.

- Vacuum erection devices: These can assist in achieving an erection by creating a vacuum that draws blood into the penis.

3. Ejaculation Issues: If you are experiencing dry orgasms, a urologist can evaluate the underlying cause and discuss potential treatments, which may include:
- Medications: Certain medications can help facilitate ejaculation.

- Surgical options: In some cases, surgical intervention may be necessary to restore normal ejaculation.


Long-term Considerations
It is essential to understand that while these complications can be distressing, they are not uncommon following urethral injuries. The impact on your quality of life can be significant, but many patients find that with appropriate treatment, they can regain function and improve their sexual health.


Conclusion
Given your situation, I strongly recommend that you seek evaluation from a urologist who can provide a comprehensive assessment of your condition. They can help determine the best course of action tailored to your specific needs. Additionally, addressing any psychological aspects of your recovery is equally important, as mental health plays a crucial role in sexual function.
Remember, you are not alone in this journey, and there are effective treatments available to help you regain your sexual health and overall well-being.

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