title: Correction of Retrograde Ejaculation in Patients with Diabetes Mellitus Using Endourethral Collagen Injection: Preliminary Results.
abstract: Diabetic neuropathy secondary to diabetes mellitus type 1 (DM1) is responsible for retrograde ejaculation (RE) in 5-18% of cases. Medical treatment of RE is based either on increasing the sympathetic tone of the bladder or on decreasing the parasympathetic activity. However, the onset of side effects and the lack of response should be considered.
  
  
  
  The aim of this study was to analyze long-term outcome of endourethral injection of volume-forming material (VFM) of collagen type 2 into bladder neck submucosa in patients with RE secondary to DM1.
  
  
  
  Twenty-four patients with complete RE refractory to imipramine and DM1 were included in the study. Patients were single-blinded randomized according to a computer-generated random sequence with a 1:1 ratio in two treatment groups, namely group A (endourethral collage type 2 injection) and group B (endourethral saline water injection). New technique includes an endoscopic injection of VFM such as collagen (Correcting MIT®, Ltd. minimally invasive technologies, Moscow, Russia) into bladder neck submucosa. Primary endpoint of the study was the reduction of semen antegrade volume (mL). Secondary endpoints were considered as the changes of antegrade count (millions/mL), antegrade total motility (%), antegrade progressive motility (%), State-Trait Anxiety Inventory, Beck Depression Questionnaire and International Index of Erectile Function (IIEF-5). Pregnancy rate was calculated in each group.
  
  
  
  Twenty-three patients completed the study. In group A, significant differences from baseline to 12 months were observed relative to antegrade volume (mL) (mean difference: 0.71, P < 0.05), antegrade count (millions/mL) (mean difference: 45.6, P < 0.05), antegrade total motility (%) (mean difference: 15.4, P < 0.05) and antegrade progressive motility (%) (mean difference: 8.4, P < 0.05). In group A, we observed significant differences in terms State-Trait Anxiety Inventory (mean difference: -20.5, P < 0.05) and Beck Depression Inventory (mean difference: -8.4, P < 0.05) with significant differences compared with group B. We observed significant improvements in group A vs. group B when considering primary and secondary endpoints of the study, but not for the IIEF-5.
  
  
  
  Correction of RE in DM1 patients could be achieved with endourethral injection of collagen type 2.
authors.affiliation: Andrological and Urological Department, Endocrinological Research Centre, Moscow, Russia.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Kurbatov
authors.affiliation: Department of Urology, University of Catania, Catania, Italy.
authors.forename: Giorgio Ivan
authors.initials: GI
authors.lastname: Russo
authors.affiliation: Andrological and Urological Department, Endocrinological Research Centre, Moscow, Russia.
authors.forename: G R
authors.initials: GR
authors.lastname: Galstyan
authors.affiliation: Andrological and Urological Department, Endocrinological Research Centre, Moscow, Russia.
authors.forename: Roman
authors.initials: R
authors.lastname: Rozhivanov
authors.affiliation: Andrological and Urological Department, Endocrinological Research Centre, Moscow, Russia.
authors.forename: Alexander
authors.initials: A
authors.lastname: Lepetukhin
authors.affiliation: Andrological and Urological Department, Endocrinological Research Centre, Moscow, Russia.
authors.forename: Sergey
authors.initials: S
authors.lastname: Dubsky
authors.affiliation: Andrological and Urological Department, Endocrinological Research Centre, Moscow, Russia.
authors.forename: Y G
authors.initials: YG
authors.lastname: Shwartz
authors.affiliation: Department of Urology, University of Catania, Catania, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Cimino
authors.affiliation: Department of Urology, University of Catania, Catania, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Morgia
authors.affiliation: Department of Experimental Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Sansalone
mesh_terms: D000328:Adult; D024043:Collagen Type II / Q000008:administration & dosage*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000150:complications* / Q000503:physiopathology; D004542:Ejaculation / Q000187:drug effects*; D007172:Erectile Dysfunction / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D055101:Semen Analysis; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000473:pathology*; D014563:Urodynamics; D013521:Urologic Surgical Procedures, Male / Q000379:methods*
chemical_list: D024043:Collagen Type II
keywords: Anejaculation; Autonomic Neuropathy; Collagen; Diabetes; Infertility; Retrograde Ejaculation