Urology: ejaculatory side effect of alpha-blockers: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Urology: ejaculatory side effect of alpha-blockers

Sample item

A 62-year-old man starting tamsulosin for lower urinary tract symptoms reports that orgasm is preserved but he now produces very little ejaculate. What explains this?

AFailure of bladder neck closure causing retrograde ejaculationBDamage to the pudendal nerve supplying the bulbospongiosusCSuppression of testosterone synthesis by the drugDObstruction of the ejaculatory ducts by prostatic swelling

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Failure of bladder neck closure causing retrograde ejaculation

Alpha-1A blockade relaxes smooth muscle of the bladder neck and prostate. The bladder neck does not close during emission, so semen passes into the bladder. It is harmless and reversible, but patients should be warned.

Option by option

A. Failure of bladder neck closure causing retrograde ejaculation (correct)
Correct. A relaxed bladder neck allows semen to flow back into the bladder.
B. Damage to the pudendal nerve supplying the bulbospongiosus
The pudendal nerve is not affected by the drug and its injury would impair orgasm and erection.
C. Suppression of testosterone synthesis by the drug
Tamsulosin does not affect testosterone production.
D. Obstruction of the ejaculatory ducts by prostatic swelling
Prostatic swelling is not caused by the drug, and the effect is functional rather than from duct obstruction.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is A, Failure of bladder neck closure causing retrograde ejaculation. Alpha-1A blockade relaxes smooth muscle of the bladder neck and prostate.

Why is "Damage to the pudendal nerve supplying the bulbospongiosus" not the answer?

The pudendal nerve is not affected by the drug and its injury would impair orgasm and erection.

Why is "Suppression of testosterone synthesis by the drug" not the answer?

Tamsulosin does not affect testosterone production.

Why is "Obstruction of the ejaculatory ducts by prostatic swelling" not the answer?

Prostatic swelling is not caused by the drug, and the effect is functional rather than from duct obstruction.

What concept does this question test?

It tests Urology: ejaculatory side effect of alpha-blockers in General Surgery. The bladder neck does not close during emission, so semen passes into the bladder. It is harmless and reversible, but patients should be warned.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Urology: ejaculatory side effect of alpha-blockers?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.