Successful disc surgery after 17 years of erectile dysfunction caused by a "silent" disc protrusion

A 35-year-old male with normal erectile function up until the age of 18 years subsequently suffered permanent erectile dysfunction for the next 17 years. At the age of 15 years he had fallen from a horse and landed on his buttocks. He also complained of slight voiding dysfunction. Uroflowmetry showed reduced flow, indicating a possible common neurogenic cause of the disturbed bladder function and erectile dysfunction. CT of the lumbar spine showed a large protrusion of the intervertebral disc L5-S1. After operative removal of the protrusion, a normal erection was achieved after 15 days and urine flow improved at 1 and 2 months and became normal after 3 months. Both erectile and bladder function continued to be normal 10 years later. Thus, the effects of long-lasting mechanical compression of parasympathetic nerves need not be irreversible. Uroflowmetry is also a test for neurogenic aetiology of erectile dysfunction, as bladder contractility and erection are both dependent upon parasympathetic innervation from the spinal segments S2-S4.