(302) THE PREVALENCE OF PHOSPHODIESTERASE-5 INHIBITOR USAGE IN MEN WITH RETROGRADE EJACULATION

Abstract Introduction Retrograde ejaculation (RE) represents a disruption and reversal in the normal antegrade seminal pathway, frequently resulting in sexual dissatisfaction and potential subfertility among men. Established etiologies of RE include alpha-adrenergic blockers used for benign prostatic hyperplasia (BPH) and certain psychotropic medications; however, the exact mechanism of action is not yet understood. Phosphodiesterase-5 inhibitors (PDE5Is), which like alpha-adrenergic blockers similarly result in vasodilation, are commonly administered for lower urinary tract symptoms, including erectile dysfunction and BPH. Despite their widespread use, there is limited literature exploring the association between PDE5I administration and the onset of retrograde ejaculation. Objective The purpose of this study is to elucidate if a relationship exists between PDE5I usage and retrograde ejaculation. Methods An IRB-approved retrospective review at a tertiary referral center identified men with a diagnosis of retrograde ejaculation via ICD-9 or ICD-10 codes and through retrograde semen analysis. Exclusion criteria included men without retrograde ejaculation based on semen analysis or electronic health record review. Baseline demographics included comorbidities, medications, and PDE5I usage. Data were analyzed using descriptive statistics and chi-square tests. Results Search criteria resulted in 98 male patients with a diagnosis of retrograde ejaculation (93 via ICD-9 or 10 code, 5 confirmed via semen analysis with post-ejaculatory urinalysis) with a mean age of 51.68 ± 15.99 years. 19 of these patients (19.4%) had recorded use of PDE5I at the time of RE diagnosis. 26 of the resulting patients (26.5%) were previously exposed to PDE5Is at the time of RE diagnosis. Men who were previously prescribed PDE5Is were more likely on average to be older at time of diagnosis (58.19 ± 13.31 years, p = 0.016). There were no statistically significant differences in BMI, race, ethnicity, smoking status, or presence of diabetes between men with previous PDE5I usage versus those without (p > 0.062). Of the men exposed to PDE5Is at any point, 34.6% were on sildenafil, 30.8% were on tadalafil, and 34.6% were on a combination of the two. There was no significant difference between concomitant alpha blocker use or use of psychotropic medications in men who had a history of PDE5Is usage compared to those who had not (p > 0.086). Conclusions In our findings, 19.4% patients had noted concurrent PDE5I use at the time of diagnosis of retrograde ejaculation. The use of PDE5I therapy is not uncommon in men with retrograde ejaculation. Further prospective studies to navigate this association are warranted. Disclosure No.