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Harrison 11-02-2006 09:16 AM

I sometimes speak with patients to offer support in any way that I can. Occasionally, a patient will have complications from surgery that include nerve damage. And sometimes, that nerve damage results in sexual dysfunction (usually males). Even though people on this forum are anonymous, many choose not to discuss things like retrograde ejaculation and/or loss of sexual sensation after surgery. And that’s too bad, as discussions can inform other patients trying to weigh all the risks of spine surgery.

While arthroplasty is often an excellent option for those qualified patients that require a radical solution, patients should be fully informed of ALL the risks & complications associated with an anterior lumbar procedure. To remedy this sensitive information deficit, I’ve collected a short list of citations from the web, which discusses this issue in detail. Please consider:

- These are dated articles and much has improved in surgical training programs. However, this must be tempered with the large number of surgeons that are new to arthroplasty procedures.
- The different approaches each have their own risks.
- There are even differences between surgical techniques across borders. E.g., some German surgeons do their own “approach,” while their American colleagues have their vascular surgeon perform the surgical approach. We’ve seen some of the pros and cons associated with these differences.
I hope this information helps patients in some way, and thanks for discussing this topic openly.

“…The potential disadvantages of disc arthroplasty are significant. The anterior approach to the lumbar spine has intrinsic risks. A surgeon familiar with this approach is necessary to perform the approach since the aorta and common iliac vessels lie anterior to the lower lumbar spine. In men, the superior hypogastric plexus can be injured, resulting in retrograde ejaculation. Furthermore, a repeat retroperitoneal approach is difficult, if not impossible, and dissection and mobilization of the vessels places the patient at significant risk of hemorrhage, particularly if performed by a surgeon unaccustomed to this approach…”

“…The incidence of retrograde ejaculation in men after anterior lumbosacral spinal surgery has been reported to range from 0.42% to 5.9%…”

A 1995 European Journal (eleven years old!) about anterior lumbar fusion procedures cites:

Retrograde ejaculation has been underestimated as a complication of anterior interbody fusion in multioperated low back patients. The possibility of this complication should be kept in mind when planning a transabdominal approach for interbody lumbar fusion in male patients. We do not recommend the transabdominal approach in male patients because of the risk of retrograde ejaculation.

Though this report is more than three years old, it appears to be one of the most credible & recent studies on the topic. Here are a few excerpts:

“…The incidence of retrograde ejaculation in men after anterior lumbosacral spinal surgery has been reported to range from 0.42% to 5.9%…

…CONCLUSIONS: A transperitoneal approach to the lumbar spine at L4-L5 and L5-S1 has a 10 times greater chance of causing retrograde ejaculation in men than a retroperitoneal approach…”

GregH 11-19-2006 11:53 AM

Thanks for posting this. I have not posted here on the forum about this (although I have discussed it with a number of people in private channels and I agree it's an important topic to discuss, so I am replying here). After my surgery in early 2006, I have this problem. I knew there was a risk and that it was relatively small but that it might happen. I am workig with a urologist but its completely unknown whether it will ever get better.

It is, I agree, important to know and fully accept the risks ahead of time. Even having done that, for a period of time I had a diffcult time accepting the side effect of an otherwise amazing and worthwhile surgery. If I had it all to do over, I would do so, but I'd make a visit to a facility so I could bank some child-making cells, since that would have simplified things compared to where I am now.

Anyone who has this problem now, or who has a need to discuss the risks can feel free to private message me. Knowldge is power and support is important, too.


Alastair 11-19-2006 01:13 PM

From the FAQ`s

The ADR doctors warn us that retro ejaculation can occur what is it?

Retro ejaculation is where the sperm is ejaculated into the bladder rather than outwards.

Because of the nature of ADR surgery sometimes, they do give the statistics of 2%, there may be a chance that retro ejaculation may occur due to damage to the prostate gland.

In studies in Korea, most patients recover within 12 months and there is medication which can help to recover from this. However, if you have not completed your family, a giant donation to a sperm bank would be a good insurance.

Somewhere in the 100`s of postings I have done is a medication which has been used- - - can`t find it at short notice- --Isn`t that always the case


GregH 11-19-2006 01:29 PM

If you can find the old posts and information about the medication, please add the info here. I think this is definitely important enough of a topic to have a single place to find links, and this seems like an approproate thread.

Harrison 03-19-2007 10:06 AM

I was recently speaking with a patient about his post-op complication. Though this particular case did not involve sexual dysfunction, it did involve an unusually “male” complication: black and blue testicles. I’ve only heard of this one other time, but I just wanted to let others know about it.

I don’t know much about the cause of this unusual post-op symptom. But you’ll be glad to know that this particular “father and his new baby disc” are doing fine now!

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