Tamsulosin誘發逆行性射精之副作用與處置建議：系統性文獻回顧

陳曉芳¹、蕭亞芝¹、鄭如惠²、黃品叡^3,4,5

1李綜合醫療社團法人苑裡李綜合醫院 醫療部 專科護理師小組

2李綜合醫療社團法人苑裡李綜合醫院 護理部

3李綜合醫療社團法人大甲李綜合醫院 外科部 泌尿外科

4國立陽明交通大學 跨領域醫學博士學位學程

5亞洲大學 食品營養與保健生技學系

Tamsulosin-Induced Retrograde Ejaculation: Adverse Effects and Recommended Management – A Systematic Literature Review

Hsiao-Fang Chen¹, Ya-Chih Hsiao¹, Ru-Hui Cheng², Pin-Jui Huang^3,4,5

1Division of Nursing Participants, Department of Medical Affairs, Yuanli Lee Hospital

2Nursing Department, Yuanli Lee Hospital

3Division of Urology, Department of Surgery, Dajia Lee Hospital

4Ph.D. Program in Interdisciplinary Medicine, National Yang Ming Chiao Tung University, Taipei

5Department of Food Nutrition and Health Biotechnology, Asia University, Taichung

Introduction:

Tamsulosin, a selective α1A-adrenergic receptor antagonist, is widely prescribed for lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). Although generally well tolerated, ejaculatory dysfunction—particularly retrograde ejaculation or anejaculation—is a recognized adverse effect that may affect patient quality of life and treatment compliance. This systematic literature review aims to evaluate the incidence, mechanisms, clinical impact, and management strategies for tamsulosin-induced retrograde ejaculation.

Materials and Methods:

A systematic literature search was conducted using PubMed, Scopus, and Web of Science databases for studies published on tamsulosin-associated ejaculatory dysfunction. Keywords included “tamsulosin,” “retrograde ejaculation,” “ejaculatory dysfunction,” and “alpha-blocker.” Randomized controlled trials, cohort studies, meta-analyses, and review articles were included. Studies focusing on incidence, mechanism, and management strategies were analyzed.

Results:

Ejaculatory dysfunction is one of the most common sexual side effects associated with tamsulosin therapy. Reported incidence varies widely across studies, ranging from approximately 4–15% in clinical trials to higher rates in observational studies. The mechanism is primarily related to selective α1A-adrenergic receptor blockade, which relaxes smooth muscle in the bladder neck, prostate, vas deferens, and seminal vesicles, leading to impaired emission and retrograde flow of semen into the bladder. Some studies suggest that many cases described as retrograde ejaculation are actually anejaculation due to impaired seminal emission rather than true retrograde flow. The condition is usually reversible after discontinuation or dose adjustment of tamsulosin. Management strategies include dose reduction, intermittent dosing, switching to alternative α-blockers such as alfuzosin, or discontinuing the medication if symptoms are bothersome.

Discussion:

Tamsulosin has a higher incidence of ejaculatory dysfunction compared to non-selective α-blockers due to its high affinity for α1A receptors involved in the ejaculatory emission phase. Although not life-threatening, retrograde ejaculation may significantly impact sexual satisfaction and fertility. Therefore, clinicians should inform patients about this potential side effect before initiating therapy and consider alternative medications in sexually active or younger patients.

Conclusion:

Tamsulosin-induced retrograde ejaculation is a common but reversible adverse effect related to α1A-adrenergic receptor blockade. Patient counseling, dose modification, intermittent therapy, and switching to alternative α-blockers are effective management strategies. Clinicians should individualize treatment based on patient age, sexual activity, and treatment goals.