Seminal “Incontinence”-or Something Else?

My patient occasionally has seminal "leakage" from the penis. He has no otherurinary complaints and no history of any sexually transmitted disease. Urinalysisreveals only sperm in the urine. MRI of the prostate and seminal vesicle shows nofistulas. The man is 36 years old, married with 1 child, and otherwise healthy.Does this discharge of semen result from seminal vesicle congestion caused byinfrequent ejaculation?
---- MDIt seems you suspect that "overflow leakage" of semen may occur in congestedseminal vesicles in a manner analogous to the "overflow urinary incontinence"that sometimes results in patients with urinary retention. Most likely,it does not.The kidneys produce urine continuously, and the bladder serves as apassive storage reservoir for the urine produced. In normal micturition, thebladder actively contracts; when its passive storage capacity is exceeded, overflowurinary incontinence may occur. The seminal vesicles, however, haveboth secretory and storage functions--as well as a contractile/excretory function.Because the seminal vesicles produce most of the seminal fluid (at most10% of ejaculate volume is produced by the testis and epididymis), they likelypossess some degree of secretory autoregulation.Moreover, men who are unable to have seminal emission and ejaculationbecause of sympathetic denervation of the seminal vesicles and ejaculatoryducts--resulting, for example, from non-nerve-sparing retroperitoneal lymphnode dissection--do not demonstrate overflow leakage of semen. Retrogradeejaculation or antegrade ejaculation may occur, however, when transrectal electro-ejaculation is performed in these men.Your patient may have premature or "inappropriate" ejaculation (ie, ejaculationthat occurs outside the context of sexual/erotic stimulation and/orthoughts). Consider a therapeutic trial of a selective serotonin reuptake inhibitor(eg, fluoxetine, paroxetine, sertraline, or citalopram). Resolution of the undesiredseminal discharge during treatment would establish the diagnosis.¹-- Benjamin N. Hendin, MD
    Staff Urologist
    Kelsey-Seybold Clinic
    Houston

References:

REFERENCE:
1.

McMahon CG, Touma K. Treatment of premature ejaculation with paroxetine hydrochloride.

Int J Impot Res.

1999;11:241-246.