Dear Dr. Motola:** After having very successful Green Light PVP surgery, I do not ejaculate. I was told that about 33% of men can still ejaculate normally after this procedure. Why can 33% still ejaculate and the rest not? (I know that the semen goes backwards in cases like mine).**
Approximately 1/3 of patients are able to ejaculate after a Green Light PVP, with the remaining patients demonstrating either retrograde or no ejaculation. The most widely held understanding of this is that the preservation of some of the bladder neck (opening of the bladder between the prostate and the bladder) is preserved during the procedure. During ejaculation the bladder neck is supposed to close down, forcing the ejaculate forward through the penis. If the bladder neck remains open during ejaculation, then the semen will flow "retrograde"" or backwards into the bladder. If the verumontanum (the opening of the ejaculatory duct at the level of the prostate) were lasered, obstruction could occur and therefore also prevent ejaculation.