Retrograde ejaculation as an initial presenting symptom of type 2 diabetes mellitus: a case report and literature review
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Abstract:
Retrograde ejaculation (RE), known as one of the late complications of diabetes mellitus, is rarely a presenting symptom in the diagnosis of diabetes. A 30-year-old male presented with a progressive decline in ejaculate over 2-month. Lab results revealed a high random blood glucose level (425 mg/dL). A substantial number of sperm were found in the post-ejaculate urine specimens, confirming a diagnosis of RE. Further lab tests revealed an hemoglobin-A1c (HbA1c) of 12.7%, with negative results for antibodies to glutamic acid decarboxylase, insulin antigen-2, insulin receptor and islet cell, consistent with a diagnosis of type 2 diabetes mellitus (T2DM). Insulin glargine and oral anti-hyperglycemic agents were initiated. Also, imipramine and pseudoephedrine were prescribed for 4-week and then discontinued, as no positive effect on ejaculation was seen. At the 36-month follow-up, the patient had a normal glucose level with HbA1c <6.5%. However, RE persisted. RE is commonly seen as a late-stage complication among T2DM. We presented a rare case where RE was the first referred symptom of T2DM and RE persisted even after adequate control of glycemia.Keywords:
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A patient with testicular cancer (non-seminoma, stage IIB) who had undergone resection for primary disease and retroperitoneal lymph node dissection as well as chemotherapy and radiotherapy 6 years before developed iatrogenic retrograde ejaculation. The infertility was treated by oral medications, including herbal medicine and injections of a hormone preparation as well as artifical insemination of husband (AIH). After 24 sessions of AIH for 4 years, his spouse gave birth to a healthy baby girl.We believe that for patients with iatrogenic retrograde ejaculation AIH is an effective method of increasing fertility to be employed more often.
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A brief review of the literature on the physiology of ejaculation and the causes and treatment of retrograde ejaculation is made. Retrograde ejaculation following transurethral resection for bladder neck sclerosis is discussed in detail. Seventy four patients were under control for a period of 5 years--69 after transurethral resection and 5 after transurethral incision of the bladder neck. Retrograde ejaculation was observed in 8.6 per cent of the patients. The possibility to solve the fertility problems in young men, as well as to avoid this complication is discussed. Inferences are made and recommendations given for establishing the diagnosis, treatment and prophylaxis of this complication.
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Although retrograde ejaculation is a relatively uncommon cause of infertility, it is nonetheless the most common cause of ejaculatory dysfunction. Retrograde ejaculation is characterized by either all or part of the seminal fluid going into the bladder. The initial management of patients with ejaculatory dysfunction is medical therapy. In couples who have failed medical therapy, assisted reproductive techniques using sperm harvested from either the urine or the male reproductive tract would be the ultimate option. We report successful management of two couples, both men with advanced age and complete retrograde ejaculation, by intrauterine insemination in one and in vitro fertilization (IVF) using intracytoplasmic sperm injection (ICSI) in the other using sperm harvested from urine. The cases reported herein suggest that male infertility due to retrograde ejaculation may be successfully treated in men significantly older than the usual reproductive age and that traditional methods of hydration and urine alkalinization allow for the successful recovery of fertile sperm for ART. The selection of the method of ART must be individualized to the needs of each couple based upon both male and female factors.
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Retrograde ejaculation causes < 2% of male infertility but is the leading cause of aspermia. The incidence of retrograde ejaculation is increasing due to the aggressiveness of modern urologic cancer surgery and an increase in diabetes mellitus. Generally, the only adverse effect is on fertility. Various approaches have been proposed for treatment, ranging from insemination with sperm-rich urine obtained after masturbation to intracytoplasmic sperm injection (ICSI). We used a protocol involving bladder washing.Case 1 involved a man with retrograde ejaculation secondary to a successful right orchiectomy and retroperitoneal lymph node dissection for stage B1 embryonal cell carcinoma. He was treated with bladder washing and intrauterine insemination. He fathered three children from six insemination cycles. Case 2 involved a man with idiopathic retrograde ejaculation and a wife with ovulatory dysfunction. He received treatment similar to that in case 1 and fathered one child from two insemination cycles.Larger studies need to be done specifically comparing treatments. Our method resulted in four normal infants in two couples over eight total insemination cycles and, taken together with other results from the literature, seems a good choice for clinicians who are treating retrograde ejaculation for the first time. We agree with others who have recommended that in vitro fertilization/ICSI not be the first step for treating the usual couples with retrograde ejaculation.
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Objective:To investigate the clinical application and clinical observation on Insulin Glargine. Methods:Type 2 diabetes patients with NPH failure (n=42) were shifted to Insulin Glargine. Results:Diabetes patients with Insulin Glargine,blood glucose better than before. Conclusion:Compared with the NPH insulin,Insulin Glargine can simulate normal insulin secretion and lower the risk of hypoglycemia as it works to keep the blood sugar level under control,it improves the patient's quality of life significantly.
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Objective To compare quality of life and treatment satisfaction by using insulin glargine and by using NPH insulin in patients with type 2 diabetes.Methods 73 patients with type 2 diabetes were randomly divided into insulin glargine plus oral antididiabetes(OAD) or to NPH insulin(twice daily),the Diabetes Treatment Satisfaction Questionnaire(DTSQ) were compared at baseline,at weeks 12 and 24 weeks.Results In mean baseline,score were not markedly difference between two groups,and score in treatment satisfaction and flexibility at 12 weeks and 24 weeks was significantly improved with glargine compared with that for NPH(P(0.05)).Conclusion Insulin glargine impruves treatment satisfaction,and improves QoL in comparison with NPH insulin in type 2 diabetes.
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