A Rare Complication of Retrograde Ejaculation after Lumbar Sympathetic Block and its Spontaneous Recovery : A Case Report

Abstract

Bilateral block of the lumbar sympathetic nerve may lead to ejaculation disorders, but few cases have been reported. A 40-year-old man developed TAO (thromboangiitis obliterans) in his left lower extremity 18 years ago. He underwent left lumbar sympathectomy (L2-L4) for the ulcer and pain in the left extremity 2 years later. He then developed an ulcer in his right extremity and received a chemical right lumbar sympathetic block at the L3-L4 level. After the procedure, the ulcer healed and the pain disappeared, but the patient developed retrograde ejaculation, which continued for 18 months. Seven months after recovery from the retrograde ejaculation, the pain in his right extremity recurred. We recognized that a patient with left lumbar sympathectomy (L2-L4) was at risk for retrograde ejaculation when the right lumbar sympathetic nerve block was added. Thus, we blocked the right lumbar sympathetic ganglia at the L3-L4 level to ameliorate the pain and ulcer in his toes while preserving the ganglion at L2. In this case, the retrograde ejaculation lasted for 18 months. The patient’s pain in the right extremity recurred 7 months after recovery from the retrograde ejaculation. We assume that regeneration of his right lumbar sympathetic nerve contributed to the spontaneous recovery from the retrograde ejaculation, and subsequently the recurrence of the pain in the right extremity.