逆行射精误诊72例分析

Diagnostic errors analysis of retrograde ejaculation(72 cases reported)

目的探讨分析逆行射精(RE)发病率、临床误诊原因及诊治方法。方法回顾性分析2004年9月至2016年2月间昆明理工大学附属医院(云南省第一人民医院)泌尿外科和中山大学附属第一医院泌尿外科门诊、住院部收治初步诊断"梗阻性无精子症"患者中RE患者的临床资料。结果 847例经病史、体检、精液常规检查初步诊断"梗阻性无精子症"患者中72例(8.5%)经详细问诊及精液、射精后尿液检查证实为RE,所有患者都在来我院就诊前未考虑或被其他医生告知"RE"可能,其中69例无尿频、尿急、排尿不适、射精痛、血精等不适,3例曾有尿频、尿急、排尿不适、射精痛等不适;51例精液量正常(≥2mL),6例射精后尿液中仅见少于10个/HP的精子。结论 RE是男性不育症中极易被忽视和误诊的病因,所有考虑诊断"梗阻性无精子症"(尤其"先天性梗阻性无精子症")的患者应重视检测射精后尿液中有无精子,以免将RE误诊误治。对于患者仍需个体化的方案治疗。

Objective Abstract Objective To investigate the incidence rate, diagnostic method, reason of diagnostic errors and therapeutic method on retrograde ejaculation. Methods Methods A retrospective analysis was made on the clinical data of patients, who were confirmed as retrograde ejaculation（RE） in Urology Surgery of the First People＇s Hospital of Yunnan Province and the First Affiliated Hospital of Sun Yat-sen University, between September, 2004 and February, 2016. All patients were primarily diagnosed as obstructive azoospermia based on their clinical manifestation and routine semen examination. Results Results For all 847 patients diagnosed as obstructive azoospermia, we further checked their clinical manifestation, physical examination and routine semen examination, and identified 72 patients（8.5%） as retrograde ejaculation（RE） based on detailed interrogation, semen examination and uronoscopy just after ejaculation. All the 72 patients were never been told the possibility of RE from other doctors before. Three cases of 72 patients had ever felt urinary frequency, urgent micturition, urinary malaise or painful ejaculation, while the other 69 patients hadn＇t any indisposition, 51/72 patients had normozoospermia（≥2mL）,6/72 patients had less than 10 spematozoas viewable in a high power field in uronoscopy just after ejaculation. Conclusion Conclusion Retrograde ejaculation is one cause of male infertility, which is easily been neglected and misdiagnosed. All the patients who had been diagnosed as obstructive azoospermia（especially geneogenous obstructive azoospermia） should detect the urine just after ejaculation. And individual therapeutic schedule should be made for specific patient.