Retrograde Ejaculation, PAE, FLA, ETC.

In this post I'm going to write about two topics. One will, perhaps be of interest to everyone, and one will be of more interest to those in the USA. I'll cover the topic of more general interest first:

I recently had a conversation with Dr. Isaacson of UNC. During that conversation we talked about retrograde ejaculation (RE). I had always thought that it was only one thing. I was wrong.

First, some anatomy. A man's ejaculate is made up of a mixture of the sperm which come from the testicals, and the seminal fluid, which is created in the prostate. There is a valve at the top of the prostate, between the prostate and bladder. Normally, when a man ejaculates, the valve closes, the prostate contracts, and the ejaculate is forced in the only direction it can go, out the penis.

If that valve is damaged, by, for example, a TURP, in any of its many flavors and colors, and the man ejaculates, when the prostate contracts, the easier place for the seminal fluid to go is up into the bladder, where it is eventually excreted with the urine. That is the first type of RE.

A PAE, and many medications dispensed by urologists for BPH, cause less seminal fluid, or no seminal fluid at all, to be created. The result is that when the man reaches orgasm, and his prostate contracts, even though the valve at the top of his prostate has closed, there is no, or not much, seminal fluid to be forced out the end of the penis. That is the second type of "RE", though it really isn't "reverse ejaculation" at all, since there is no fluid to ejaculate. We just call it that.

I hope this clears up why some of us have this happen, and what is really going on. It also clarifies why some of the medications cause RE.

Now on to the part of this post having to do with MEDICARE and insurance in the US, and why PAE, FLA, and some other promising techniques are not covered by MEDICARE nor most insurance in the US, except for those in research studies.

In order to be covered by MEDICARE or most other types of insurance in the US, a medical procedure, device, or drug must first be approved by the FDA. Once it is approved by the FDA, everyone else jumps aboard.

There are approximately 1/4 as many interventional radiologists in the US as there are urologists. Urologists do not do PAEs, FLAs, nor some of the other promising techniques. Interventional radiologists do them. As a result of that, many urologists, and then their lobbyists, who have been making a living on TURPS for years see all that money going out the window to the interventional radiologists. So, this has become a political issue, and there are more urologists. There are also the companies who make the specialized equipment used to do the TURPS. There are millions, and perhaps billions of dollars involved.

Look, for a minute at the Urolift, another relatively new technique. It was, not surprisingly, approved by the FDA, and it is done by UROLOGISTS.

I am sure that there are many urologists who have their patients best interests at heart, or who are not even aware of these new promising techniques, but....

So what to do about it? Will these promising procedures, done by interventional radiologists, ever have a chance of being approved? What can be done about it?

Well, in one sense, there is hope, and we are it. For good or bad, in this country, at this time, most members of the House and Senate are men --- old men --like us, and most of them probably have trouble with urination, but most of them probably aren't aware of this issue, and how approval of PAE, FLA and other promising techniques could help them and us. I don't know how the current election is going to turn out, but Hillary Clinton has already supported more research on men's prostate problems. I have no idea where Mr. Trump stands on this.

We can help fix this problem. We need to write to our members of congress and the senate, make them aware of this issue, point out how promising these techniques are, and ask them to support financing of the additional research necessary to get these promising techniques evaluated, and approved by the FDA if they really work out. It will help them, and it will help us. Just as it is appropriate to support research on women's health issues, we need help on men's health issues.

I apologize for being so long winded, but this is important information. Please get it to your friends, comment here, and WRITE YOUR MEMBERS OF CONGRESS AND THE SENATE.

Neal

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