Post-micturition semen loss

Specialty: Nephrology and urology.

• defecatory or post-micturition spermatorrhea
• expulsion of seminal fluid after urinating

Why it occurs

• Hypertrophy or congestion of the seminal vesicles (with excessive accumulation of semen due to infrequent ejaculation)
• Hypertonia of the detrusor muscle and abdominal press (when making excessive urinary effort to overcome an obstruction as in BPH, the ejaculatory ducts and seminal vesicles are mechanically squeezed, leaving viscous seminal fluid)
• Excessive relaxation or weakness of the muscles of the internal urethral sphincter and ejaculatory ducts due to autonomic neuropathy (common in diabetic patients)
• Chronic prostatitis (prostatic inflammation keeps the urethra and ducts patent with ease of involuntary seminal drainage at the end of urination)

Initial workup

Microbiological analysis of seminal fluid (spermoculture); transrectal ultrasound of the prostate and seminal vesicles to rule out cystic dilation or abscesses; urodynamic study to assess voiding effort; Selective urine culture.

Standard management

• Tamsulosin — 0.4 mg daily orally to reduce urinary effort and regularize the relaxation of the bladder neck
• Ciprofloxacin — 500 mg every 12 hours PO for 4 weeks if chronic bacterial prostatitis is demonstrated as the cause
• Pelvic floor muscle strengthening exercises (male Kegel) to improve sphincter support.