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Retrograde ejaculation after anterior interbody lumbar fusion
H Tiusanen1, S Seitsalo, K Osterman
1Orthopaedic Hospital of the Invalid Foundation, Helsinki, Finland.
Summary
Anterior interbody lumbar fusion can cause retrograde ejaculation, particularly with the transabdominal approach in male patients. This complication, often underestimated, necessitates careful consideration during surgical planning.
Area of Science:
- Neurosurgery
- Urology
- Spinal Surgery
Background:
- Anterior interbody lumbar fusion is a common procedure for severe low back pain.
- Retrograde ejaculation is a potential, yet often underestimated, complication of this surgery.
Purpose of the Study:
- To investigate the incidence and risk factors of retrograde ejaculation following anterior interbody lumbar fusion.
- To evaluate the safety and efficacy of the transabdominal approach in male patients undergoing this procedure.
Main Methods:
- Retrospective study of 40 male patients who underwent anterior interbody lumbar fusion.
- Diagnosis of retrograde ejaculation based on patient interviews and, in one case, testis biopsy and vasography.
- Analysis of surgical approach, blood loss, and prior surgical history.
Main Results:
- Retrograde ejaculation occurred in 9 patients (22.5%), with permanent cases in 7 (17.5%).
- The transabdominal approach was associated with a higher incidence of retrograde ejaculation.
- Multi-operated patients and those undergoing multi-level fusions (L4-S1) showed increased risk.
Conclusions:
- Retrograde ejaculation is a significant complication of anterior interbody lumbar fusion, especially via the transabdominal route.
- The transabdominal approach is not recommended for male patients due to the risk of retrograde ejaculation.
- Surgeons should consider this risk when planning lumbar fusion, particularly in multi-operated individuals.