Editor-in-Chief: Kenneth D. Candido, MD
Background: Sympathetic neurolysis, or sympathectomy, is an established modality for the treatment of chronic pain. In cases of chronic pelvic pain (CPP), the ganglion of impar (GI) and the superior hypogastric plexus (SHP) are widely accepted targets for such therapy.
Objective: While diagnostic injections typically predate any neurolysis for the purpose of ascertaining any potential efficacy for interrupting a particular pathway, careful attention is equally paid to evaluate for possible adverse events - in the case of lumbopelvic neurolysis, retrograde ejaculation (RE) is one such possibility.
Study Design: A case series.
Setting: An outpatient pain management clinic.
Methods: We present 3 male patients with CPP treated who underwent neurolytic procedures targeting the GI and SHP.
Results: The first patient developed RE after undergoing a simultaneous neurolysis of both the SHP and GI, in the same sitting. The second and third patients both experienced temporary RE immediately after diagnostic blockades of the SHP, following GI neurolysis that was performed several weeks prior.
Limitations: Cause-effect conclusions cannot be drawn from the results of a case series.
Conclusions: RE is a potential consequence of combined or serial SHP and GI neurolysis. While neurolysis of either the GI or SHP individually have not been known to cause RE in men, this case series demonstrates the potential risk in causing it when both structures are simultaneously incapacitated in some form; as such, the authors recommend against both structures being ablated or disabled concurrently without careful evaluation with temporary blockades first. In an effort to avoid such a complication or evaluate for the possibility in a particular individual, we recommend that an individual with CPP, who has already been treated with a neurolysis, undergoes diagnostic blocks first on whichever of the 2 structures has not yet been ablated to carefully evaluate if RE will occur.