You already aware that following a prostatectomy you experience
retrograde ejaculation. This means the ejaculate is ?rerouted? into
the bladder. Spermatazoa can be found in a post-ejaculatory urine
sample. This also means that there is no ?build up? of ejaculate, as
it is passed out with urine when you empty your bladder.
?During normal ejaculation, semen travels from the prostate out
through the urethra (urine tube) to the tip of the penis. However, if
a tiny valve at the opening of the bladder fails to close, semen can
travel the opposite direction ("retrograde") and end up in the bladder
instead. The semen then mixes with urine and passes out through the
urethra the next time that the bladder is emptied.?
The swelling you are experiencing may be epididymitis, which is an
inflammation or infection of the epididymis, small tubules on the
testes, that connect to the vas deferens and serve as sperm storage
areas. The symptoms include groin and scrotal pain and swelling. Pain
often increases throughout the day. Occasionally, the pain becomes so
severe, a patient my not be able to walk. The causative organisms are
E.coli, in 80% of the cases, followed by c.trachomatis and N.
gonorrheae, although sometimes, no organisms are found. Epididymitis
can be sexually transmitted or from an injury to your scrotum. Men
taking the cardiac anti-arythmic drug, amiodarone (Cordarone) are at
higher risk for epididymitis than men who are not using this drug.
You can see an illustration here:
?Epididymitis develops after prostatectomy especially in postoperative
urinary tract infection, and in patients with risk factors (retention
of urine, recurrent residual urine, infected urine, and after
adenomectomy). In comparison with the time before specific antibiotic
therapy, postoperative epididymitis has fallen by 50% with preliminary
antibiotic treatment. Postoperative epididymitis very rarely occurs
under treatment with gentamicin.?
?Older men who have undergone transurethral prostatectomy may also
develop epididymitis, since resection in the region of the
verumontanum (An elevation, or crest, in the wall of the urethra where
the seminal ducts enter it.) may allow reflux of infected urine into
the vas deferens.
Ultrasound (US) is the primary imaging modality, and is particularly
helpful in the distinction of acute epididymitis from testicular
torsion, which is of critical importance in management. At US, the
head and body of the epididymis are enlarged and exhibit altered
echogenicity (Fig.1). Echogenicity is often reduced, but may be
increased. The entire epididymis may be involved, or just the head. A
reactive hydrocoele is often present. Up to 20% of patients have
superimposed orchitis, manifested sonographically as testicular
enlargement and hypoechogenicity.?
In some patients, urine may leak out of the bladder, into the vas
deferens, causing an inflammation/irritation, leading to epididymitis.
?Epididymitis can also be caused by injury or infection of the scrotum
or by irritation from urine that has accumulated in the vas deferens
(the duct through which sperm travels after leaving the epididymis).?
?Signs & Symptoms
Fever and chills.
Scrotal swelling, pain and tenderness, sometimes extending to the
groin region, may begin relatively acutely over several hours.
May have urinary symptoms, such as pain when passing urine, blood
in urine and urinary frequency.
Recent illness, especially acute or chronic prostatitis, urethritis,
or urinary tract infection.
Indwelling urethral catheter
Urethral instrumentation and transurethral surgery .g. prostatectomy.
In children- congenital abnormalities of the urinary tract, as
mentioned above under causes.
?Epididymitis is typically caused by bacterial organisms associated
with urinary tract infections, sexually-transmitted diseases (such as
chlamydia and gonorrhea), prostatitis (infection of the prostate) or
prostatectomy (removal of the prostate). An increased risk is
associated with sexually active men who are not monogamous and do not
use condoms. Men who have recently had surgery or have a history of
structural problems involving the genito-urinary tract are also at
increased risk (regardless of their sexual behaviors).?
?Epididymitis (eh-pih-did-ih-mi-tis) is an infection or swelling of
the epididymis (eh-pih-did-ih-mus). The epididymis is the tube that
carries sperm from the testicles to the penis. There are 2 of these
tubes, 1 attached to each testicle. Epididymitis is common in men 19
to 35 years old. It may take 2 to 4 weeks for your epididymis to get
Treatment of Epididymitis:
Recurrence is not uncommon, even with prompt treatment. Cipro is one
of the antibiotics of choice, particularly for men over 35. Men are
advised to avoid beverages with caffeine, such as coffee and
caffeinated sodas (colas, Dr. Pepper, Mountain Dew, etc.) during a
painful episode. Constipation can aggravate epididymitis - stool
softeners may be useful if this becomes a problem.
?Bed rest is recommended until symptoms subside, and patients are
advised to wear athletic supporters when they resume normal
activities. If pain is severe, a local anesthetic like lidocaine
(Xylocaine) may be injected directly into the spermatic cord. Scrotal
ice packs and scrotal elevation are also recommended.?
?Antibiotics are prescribed. Chlamydial infections are usully treated
using tetracycline. Sexual partners may also be treated. Bedrest, with
elevation of the scrotum and ice packs applied to the area, is
recommended. It is very important to have a follow-up visit with your
health care provider to evaluate if the infection has completely
?Resting may help you feel better. Putting ice or heat on your scrotum
may lessen the pain. Using a scrotal support or athletic supporter
(jock strap) may also help lessen the pain.?
Sexually transmitted pathogens are the organisms most often
responsible for epididymitis in the patient younger than 35 years.
Chlamydia trachomatis is responsible for nearly 50-60% of cases, while
Neisseria gonorrhoeae is the second most common organism responsible
In patients older than 35 years, coliform bacteria predominate because
underlying obstructive urinary disease is often present. However,
sexually transmitted pathogens are still a consideration. Chemical
epididymitis, which represents an inflammatory process due to the
reflux of sterile urine, occurs infrequently.?
?Complications of prostatectomy include impotence and incontinence.
However, your chances are still good that you will remain potent and
that any incontinence will be temporary. After prostate removal, your
ejaculations will be dry due to retrograde ejaculation. However, the
experience of orgasm should remain unaffected and therefore enjoyable.
Worrying too much about the ability to function sexually can create a
psychological stumbling block that by itself can impair sexual
functioning. One way to reduce the tension is to learn as much as
possible about the surgical procedure and to thoroughly discuss sexual
issues involving the operation with your
Prevent future bouts of epididymitis by practicing safe sex, and
emptying your bladder often.
Other possible causes *could* be lymphedema, infected/swollen lymph
nodes, or hernia (which your doctor has ruled out).
Swollen Lymph Nodes
Swollen or inflamed lymph nodes can be caused by epididymitis or from
a non-related infection.Organisms(bacteria) may have been dormant
since your prostatectomy or the lymph swelling may have nothing at all
to do with your prostatectomy, and due to a current infection. (More
?The lymph nodes can become swollen. This generally results from
infection, inflammatory conditions, an abscess, or cancer. Other
causes of enlarged lymph nodes are extremely rare. By far, the most
common cause of lymph node enlargement is infection.
As a rule, when swelling appears suddenly and is painful, it is
usually caused by injury or an infection. Enlargement that comes on
gradually and painlessly may result from cancer or a tumor.?
?Lymph nodes can usually be distinguished from other growths because
they generally feel small, smooth, round or oval-shaped and somewhat
mobile when attempts are made to push them sideways?
?Radical prostatectomy, a procedure that removes the prostate gland,
seminal vesicles and sometimes the nearby pelvic lymph nodes, can lead
to lymphedema. Lymphedema can appear any time after surgery or
radiation treatment including many years later.
When the condition develops very soon after surgery, it is usually
mild, and goes away within one to two weeks. It can also develop six
to eight weeks after surgery or radiation. Again, this type of
lymphedema usually goes away in a few weeks.
Unfortunately, the more common form of lymphedema in cancer survivors
develops slowly over time. It may show up many months or even years
after treatment ends and swelling can range from mild to severe. In
most cases however, lymphedema appears between six and 12 months after
treatment. While people who have many lymph nodes removed and
radiation therapy have the highest risk of developing lymphedema, some
high-risk patients won?t develop the condition.?
?Lymphedema is a prevalent disease. Approximately 10 million people
have lymphedema secondary to breast and pelvic cancer therapy,
recurrent infections, injuries, or vascular surgery.?
?Lymphedema is swelling resulting from the accumulation of lymphatic
fluid. It can affect the arms, hands, legs, feet and trunk, and less
commonly the face and genitalia. In women who have undergone
mastectomy or lumpectomy, lymphedema may occur in the arm of the
affected side. Lymphedema can also result from lower abdominal surgery
such as hysterectomy, cyst removal, and prostatectomy.?
?After a radical prostatectomy or pelvic radiation, there is an
increased risk for a prostate cancer patient to develop lymphedema due
to the surgical incisions, removal of lymph nodes and the radiation
scarring. Additionally, advancing prostate cancer can block or reduce
lymphatic or venous outflow from the lower extremities and pelvis
leading to lower extremity edema.?
You may be interested in reading these answers for some additional information:
I hope this has helped you understand the possible causes of your
condition. Remember, your doctor is the one who is familiar with your
medical history, and best able to diagnose you.
If any part of this answer is unclear, please request an Answer
Clarification, before rating. This will enable me to assist you
further, if possible.
retrograde ejaculation post prostatectomy
groin swelling post prostatectomy