Sexual Dysfunction and Retrograde Ejaculation After Primary Anterior Lumbar Interbody Fusion in Male Patients: A Survey on 98 Patients.

BACKGROUND: Anterior lumbar interbody fusion (ALIF) is a well-established procedure for the treatment of spondylosis, spondylolisthesis, and degenerative disc disease but can cause sexual dysfunction and retrograde ejaculation (RE). OBJECTIVE: We assessed the occurrence of sexual dysfunction and RE and explored associations between patient and surgical characteristics with sexual dysfunction, RE, and patient satisfaction with the outcome of surgery. METHODS: This is a retrospective survey study. A short questionnaire on changes in sexual function, RE, and patient satisfaction was sent to 170 male patients aged 18 to 60 years who underwent a primary ALIF at L5/S1, L4/L5, or both via retroperitoneal approach between 2015 and 2020 in a high-volume spine centre in Switzerland. Factors associated with changes in sexual function and with RE were examined in univariable and multivariable logistic regressions. The multivariable logistic regression model was adjusted for age at surgery, time since surgery, level of surgery, and fusion material. The associations between satisfaction with the outcome of surgery and time since surgery and changes in sexual function were also assessed using univariable logistic regression. RESULTS: Of the 170 patients contacted, 98 (58%) agreed to participate. The most frequent fusion level was L5/S1 (n = 74, 76% of respondents), and InductOs was generally used (n = 69, 70%). Overall, 21 patients (21%) reported changes in sexual function, and 11 (11%) felt signs of RE. The majority of patients were satisfied with the surgical outcome (n = 83, 85%) and would undergo the surgery again (n = 83, 85%). In all regression models, changes in sexual function and RE were not associated with any of the studied factors. The odds of being satisfied with the surgery were 4× higher for patients who did not observe changes in sexual function than those who did (95% CI, 1.24-12.86). CONCLUSIONS: The risk of sexual dysfunction and RE after ALIF is relevant, and patients need to be adequately informed about these complications, especially if they want to have children. At the same time, the ALIF procedure remains a successful treatment option with high patient satisfaction. CLINICAL RELEVANCE: The study emphasizes the need to provide patients with adequate information regarding ALIF surgery.