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Retrograde ejaculation after RPLND | CION Cancer Clinics
Retrograde ejaculation means that at orgasm, semen flows backwards into the bladder instead of out. It can follow RPLND when the nerves that close the bladder neck are cut or bruised during the operation. Orgasm feels the same, erections are unchanged, and the semen leaves harmlessly with urine. The practical effect is on fertility, and there are ways round that. This page explains what it is, what to do, and what can be tried. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What is retrograde ejaculation after RPLND?
- What retrograde ejaculation does and does not affect
- What to do if you think this has happened to you
- Four things men tell us, and what is actually true
- How it usually unfolds after the operation
- Words you will see, in plain language
- What can be tried, who it does not suit, and what this page cannot tell you
- Common questions about retrograde ejaculation after RPLND
The short answer
What is retrograde ejaculation after RPLND?
Retrograde ejaculation means that at orgasm, semen flows backwards into the bladder instead of out through the penis. You feel the climax as normal, but little or no fluid appears, and the next time you pass urine it may look cloudy. It happens after RPLND when the nerves that close the bladder neck during orgasm are cut or bruised, because those nerves run through the area the operation clears.
Why it is not dangerous
Semen in the bladder does no harm. It mixes with urine and leaves the body the next time you go. There is no build-up, no infection risk from it, and no effect on the bladder or kidneys. The problem it causes is a practical one: sperm are not reaching a partner, so natural conception becomes difficult.
Why it happens to some men and not others
It depends on whether the surgeon could spare the nerves. In a primary operation on small nodes, sparing usually succeeds and most men ejaculate normally. After chemotherapy, scar tissue can hide the nerves or a mass can wrap around them, and sparing is not always possible. Nerves that were only bruised, not cut, often recover over months.
What changes, what does not
What retrograde ejaculation does and does not affect
Orgasm: unchanged
The feeling of climax comes from nerves and brain pathways the operation does not touch. Men describe a normal orgasm with no fluid, which is sometimes called a dry orgasm.
Erections: unchanged
The nerves for erection sit low in the pelvis, well below the operation. If erections change after surgery, look first at tiredness, low mood and worry, all of which are common after cancer treatment and all of which can be helped.
Urine: cloudy after sex
The semen leaves with the next urine, which may look cloudy or milky. This is expected and harmless. It is not an infection and needs no treatment.
Burning, fever or blood in the urine are different and should be checked.Fertility: affected, not ended
Sperm are still made by the remaining testicle. They are simply going the wrong way. They can be recovered from urine after orgasm, or taken directly from the testicle, and used in fertility treatment.
Options your team may raise
- Sperm banked before surgery
- Sperm collected from urine after orgasm
- Sperm taken from the testicle under local anaesthetic
Not sure whether this applies to you?
Ask an oncologistIf you notice it
What to do if you think this has happened to you
Tell your team, plainly
Say it at the next follow-up, or call before then. Surgeons expect this question after RPLND and it is not an embarrassing one to them. Write it down and hand it over if that is easier.
A simple urine test confirms it
You pass urine shortly after orgasm and the sample is checked for sperm. If sperm are present, the diagnosis is made. No scan and no further procedure is needed.
Give it time
Nerves that were handled but not cut can recover slowly. Your team may suggest waiting and checking again over the following months before deciding anything further.
If you want children, see a fertility specialist early
Do not wait until the year is out. A fertility clinic can collect sperm from urine or from the testicle and plan treatment around that. Starting the conversation early gives you more choices.
Commonly believed
Four things men tell us, and what is actually true
"No semen means I am now infertile."
Not in the way that word usually means. Sperm are still being made. They are going into the bladder instead of out, and they can be collected from there or from the testicle. Natural conception is harder; having children is still possible.
"The semen backing up will damage the bladder."
It does no damage at all. It mixes with urine and leaves the body the next time you go. There is no build-up and no pressure. Cloudy urine after sex is the only sign, and it is harmless.
"It means the surgeon made a mistake."
Usually it means the nerves could not be spared without leaving cancer behind, and the surgeon chose the cancer. That is the right choice. Ask your surgeon what they found; a good one will tell you exactly why sparing was or was not possible.
"There is nothing that can be done about it."
Some men recover on their own over months. For others, medicines that tighten the bladder neck are sometimes tried, and fertility clinics have routine ways of collecting sperm. What cannot be promised is a return to exactly how things were.
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Over the first year
How it usually unfolds after the operation
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The first weeks
Most men are not sexually active while the wound heals and are unlikely to notice anything. There is no need to test for it at this stage.
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The first time
Orgasm feels normal but little or no fluid appears. This is the moment most men realise. It is not painful, and it does not mean something has gone wrong inside.
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The following months
If the nerves were bruised rather than cut, some forward ejaculation may return gradually. Your team will ask about it at follow-up. If they do not, raise it.
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Deciding what, if anything, to do
If there is no change by the later follow-ups, the conversation turns to whether it matters for you. For a man who has finished his family, often it does not. For one who has not, fertility options are discussed.
On your notes
Words you will see, in plain language
- Bladder neck
- The ring of muscle where the bladder meets the urethra. It closes at orgasm to send semen forward. If it stays open, semen goes back.
- Post-ejaculatory urinalysis
- A urine sample given after orgasm and checked for sperm. The test that confirms retrograde ejaculation.
- Anejaculation
- No semen produced at all, forwards or backwards. Different from retrograde ejaculation, and the urine test tells them apart.
- Sperm retrieval
- Collecting sperm from urine or directly from the testicle for use in fertility treatment.
Being straight with you
What can be tried, who it does not suit, and what this page cannot tell you
Medicines that tighten the bladder neck are sometimes tried, most often pseudoephedrine, a decongestant, or imipramine, an older antidepressant used here for a different effect. They work for some men and not others, and less well when the nerves were cut rather than bruised. Whether to try one is your doctor's decision; do not buy either over the counter and start on your own.
Who these medicines do not suit
Men with high blood pressure, heart rhythm problems, an enlarged prostate or glaucoma may be advised against them. If you take other medicines, tell the prescribing doctor every one of them, including anything from an ayurvedic or homeopathic practitioner.
What this page cannot tell you
It cannot tell you whether your ejaculation will recover, or whether a medicine will help. That depends on what was done to the nerves in your operation, which only your surgeon knows. Ask them directly. And if the answer matters for a family you are hoping to have, ask for a fertility referral now rather than in a year.
If you would rather not raise this with your surgeon face to face, call the helpline and we will put the question to the team for you.Questions we are asked
Common questions about retrograde ejaculation after RPLND
Is retrograde ejaculation permanent?
Not always. If the nerves were bruised or stretched rather than cut, forward ejaculation can return gradually over months. If they were removed with a mass, it is more likely to be lasting. Your surgeon knows which happened, so ask them rather than guessing.
Will my partner be able to tell?
Only that there is little or no fluid. Sex, erections and orgasm are otherwise as before. Many couples find it easier once it has been explained to both of them, so consider bringing your partner to the appointment where it is discussed.
Can we still have children naturally?
It is difficult while ejaculation is fully retrograde, because sperm are not reaching your partner. If some forward flow returns, natural conception may become possible again. Otherwise, sperm collected from urine or from the testicle can be used in fertility treatment. A fertility clinic will explain which route fits you.
How is sperm collected from urine?
You are usually asked to take something to make the urine less acidic, then to pass urine soon after orgasm at the clinic. The sample is spun to separate the sperm, which can then be used for fertility treatment. It is a routine procedure at fertility clinics and involves no operation.
Is it the same as being impotent?
No. Impotence means being unable to get or keep an erection, and RPLND does not cause that. Retrograde ejaculation is about the direction semen travels at orgasm, nothing else. The two are often confused, and the confusion causes needless worry.
Should I have banked sperm before the operation?
If you did, use it: that is what it was for. If you did not, it is not too late to do something. Sperm are still being made and can be retrieved. Do not spend time on regret; spend it on a fertility appointment, where the practical options are laid out.
Does it affect my hormones or make me less of a man?
It has no effect on testosterone, which is made by the remaining testicle, and no effect on desire, strength, body hair or voice. It is a plumbing change, not a hormonal one. If you feel low about it, that is understandable, and a counsellor can help.
Who do I talk to about this?
Your surgeon first, because they know what was done to the nerves. Then a fertility specialist if children are on your mind. If it is hard to raise face to face, write it down, or call the helpline and ask us to put the question to your team. You will not be the first to ask.
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Sources
- Cancer Research UK — Testicular cancer: treatment
- American Cancer Society — Surgery for Testicular Cancer
- NHS — Retrograde ejaculation
- Macmillan Cancer Support — Testicular cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Nerve-sparing RPLND and ejaculationWhy it happens to some men and not othersFertility after RPLNDSperm banking, retrieval and the fertility clinicRecovery after RPLNDEverything else that changes in the first monthsThe emotional side of cancer surgeryTalking about this with a partner, and with yourself
Talk to us
Noticed a change after RPLND?
Call the helpline. We will put the question to a surgical oncologist and, if you want children, help you reach a fertility specialist early. One helpline serves every CION centre.