The use of
pseudoephedrine, an alpha agonist, for the treatment of
retrograde ejaculation is well-known, however, there is no clear consensus from the literature regarding its efficacy and treatment protocol. We evaluated the efficacy of
pseudoephedrine treatment in patients with
retrograde ejaculation, utilizing a yet undescribed short-period treatment protocol. Twenty men were medically treated with
pseudoephedrine for
retrograde ejaculation between January 2010 and May 2016 (12 with complete
retrograde ejaculation and 8 with partial
retrograde ejaculation). All patients had a semen analysis and post-ejaculatory urinalysis before and
after treatment. The treatment protocol consisted of 60 mg of
pseudoephedrine every 6 h on the day before semen analysis and two more 60 mg doses on the day of the semen analysis. Diabetes was the most common etiology for complete
retrograde ejaculation (60%), whereas an idiopathic cause was the most common etiology for partial
retrograde ejaculation (82%). Of the 12 complete
retrograde ejaculation patients treated with
pseudoephedrine prior to semen analysis, 7 (58.3%) recovered spermatozoa in the antegrade ejaculate, with a mean total sperm count of 273.5 ± 172.5 million. Of the eight patients with partial
retrograde ejaculation, five (62.5%) had a ≥50% increase in the antegrade total sperm count. In this group, the mean total sperm count increased from 26.9 ± 8.5 million before treatment to 84.2 ± 24.6 million
after treatment, whereas the percentage of spermatozoa in the urine declined from 43.2 ± 9% to 17 ± 10%, respectively (both p < 0.05). Overall, in men with
retrograde ejaculation treated with a
pseudoephedrine regimen prior to ejaculation, some improvement in seminal parameters occurred in 14 (70%) patients, with 10 patients (38.5% of all patients) achieving antegrade total sperm counts over 39 million.