Retrograde Ejaculation after Anterior Lumbar Fusion Resolved with a Plant-Based Diet: Case Report and Discussion

Retrograde Ejaculation after Anterior Lumbar Fusion Resolved with a Plant-Based Diet: Case Report and Discussion

Asef Bawahab¹, Logan Karlen², Casey Slattery³, Kushagra Verma⁴

¹General Surgery, Universal Health Services, SoCal MEC [Southern California Medical Education Consortium], Temecula, California, USA. ²University of California, Los Angeles, Los Angeles, California, USA. ³Orthopaedic Surgery, University of New Mexico Hospital, Albuquerque, New Mexico, USA. ⁴Orthopaedic Spine Surgeon, Long Beach Memorial Medical Center, Long Beach, California, USA.

This is an unusual report of a 33-year-old male with retrograde ejaculation as a complication of stand-alone L5-S1 anterior lumbar spinal fusion. This case is discussed in detail, with particular interest directed toward fertility issues and their implications. A plant-based diet was suggested as a treatment option due to the diet’s blood viscosity reduction properties. The patient initially noticed improvement after two months of starting the diet, with complete resolution of his retrograde ejaculation six months after beginning a plant-based diet. He successfully fathered a child a few years afterward.

Keywords: Retrograde Ejaculation;  Anterior Lumbar Fusion

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How to cite this article:

Asef Bawahab, Logan Karlen, Casey Slattery, Kushagra Verma. Retrograde Ejaculation after Anterior Lumbar Fusion Resolved with a Plant-Based Diet: Case Report and Discussion. International Journal of Case Reports, 2023, 7:293. DOI: 10.28933/ijcr-2023-05-2505ab

References:

1. Teng, I., Han, J., Phan, K., & Mobbs, R. [2017]. A meta-analysis comparing ALIF, PLIF,TLIF and LLIF. Journal of Clinical Neuroscience, 44, 11–17.https://doi.org/10.1016/j.jocn.2017.06.013
2. Ignarro, L. J., Cirino, G., Casini, A., & Napoli, C. [1999]. Nitric Oxide as a Signaling Molecule in the Vascular System: An Overview: Journal of Cardiovascular Pharmacology, 34[6], 879–886. https://doi.org/10.1097/00005344-199912000-00016
3. Sasso, R. C., Kenneth Burkus, J., & LeHuec, J.-C. [2003]. Retrograde Ejaculation After Anterior Lumbar Interbody Fusion: Transperitoneal Versus Retroperitoneal Exposure. Spine, 28[10], 1023–1026. https://doi.org/10.1097/01.BRS.0000062965.47779.EB
4. Revenig, L., Leung, A., & Hsiao, W. [2014]. Ejaculatory physiology and pathophysiology: Assessment and treatment in male infertility. Translational Andrology and Urology, 3[1], 41–49. https://doi.org/10.3978/j.issn.2223-4683.2014.02.02
5. Röthlisberger, R., Aurore, V., Boemke, S., Bangerter, H., Bergmann, M., Thalmann, G. N., & Djonov, V. [2018]. The anatomy of the male inferior hypogastric plexus: What should we know for nerve sparing surgery: The Anatomy of the Male IHP. Clinical Anatomy, 31[6], 788–796. https://doi.org/10.1002/ca.23079
6. Nijman, J. M., Schraffordt Koops, H., Oldhoff, J., Kremer, J., & Jager, S. [1987]. Sexual function after bilateral retroperitoneal lymph node dissection for nonseminomatous testicular cancer. Archives of Andrology, 18[3], 255–267. https://doi.org/10.3109/01485018708988491
7. Brindley, G. S., Sauerwein, D., & Hendry, W. F. [1989]. Hypogastric plexus stimulators for obtaining semen from paraplegic men. British Journal of Urology, 64[1], 72–77. https://doi.org/10.1111/j.1464-410x.1989.tb05526.x
8. Alsaid, B., Bessede, T., Karam, I., Abd-Alsamad, I., Uhl, J.-F., Benoît, G., Droupy, S., & Delmas, V. [2009]. Coexistence of adrenergic and cholinergic nerves in the inferior hypogastric plexus: Anatomical and immunohistochemical study with 3D reconstruction in human male fetus. Journal of Anatomy, 214[5], 645–654. https://doi.org/10.1111/j.1469-7580.2009.01071.x
9. Schlegel, P. N., & Walsh, P. C. [1987]. Neuroanatomical approach to radical cystoprostatectomy with preservation of sexual function. The Journal of Urology, 138[6], 1402–1406. https://doi.org/10.1016/s0022-5347[17]43655-x
10. Keast, J. R. [2006]. Plasticity of pelvic autonomic ganglia and urogenital innervation. International Review of Cytology, 248, 141–208. https://doi.org/10.1016/S0074-7696[06]48003-7
11. Dail, W. G., Moll, M. A., & Weber, K. [1983]. Localization of vasoactive intestinal polypeptide in penile erectile tissue and in the major pelvic ganglion of the rat. Neuroscience, 10[4], 1379–1386. https://doi.org/10.1016/0306-4522[83]90119-7
12. Watkins, R., Watkins, R., & Hanna, R. [2014]. Non-union rate with stand-alone lateral lumbar interbody fusion. Medicine, 93[29], e275. https://doi.org/10.1097/MD.0000000000000275
13. Lightsey, H. M., Pisano, A. J., Striano, B. M., Crawford, A. M., Xiong, G. X., Hershman, S., Schoenfeld, A. J., & Simpson, A. K. [2022]. ALIF Versus TLIF for L5-S1 Isthmic Spondylolisthesis: ALIF Demonstrates Superior Segmental and Regional Radiographic Outcomes and Clinical Improvements Across More Patient-reported Outcome Measures Domains. Spine, 47[11], 808–816. https://doi.org/10.1097/BRS.0000000000004333
14. Manzur, M., Virk, S. S., Jivanelli, B., Vaishnav, A. S., McAnany, S. J., Albert, T. J., Iyer, S., Gang, C. H., & Qureshi, S. [2019]. The rate of fusion for stand-alone anterior lumbar interbody fusion: A systematic review. The Spine Journal, 19[7], 1294–1301. https://doi.org/10.1016/j.spinee.2019.03.001
15. Lee, D. H., Lee, D.-G., Hwang, J. S., Jang, J.-W., Maeng, D. H., & Park, C. K. [2021]. Clinical and radiological results of indirect decompression after anterior lumbar interbody fusion in central spinal canal stenosis. Journal of Neurosurgery: Spine, 34[4], 564–572. https://doi.org/10.3171/2020.7.SPINE191335
16. McCarthy, M. J. H., Ng, L., Vermeersch, G., & Chan, D. [2012]. A radiological comparison of anterior fusion rates in anterior lumbar interbody fusion. Global Spine Journal, 2[4], 195–206. https://doi.org/10.1055/s-0032-1329892
17. Ochsenkühn, R., Kamischke, A., & Nieschlag, E. [1999]. Imipramine for successful treatment of retrograde ejaculation caused by retroperitoneal surgery. International Journal of Andrology, 22[3], 173–177. https://doi.org/10.1046/j.1365-2605.1999.00165.x
18. Virmani, A., Pinto, L., Binienda, Z., & Ali, S. [2013]. Food, Nutrigenomics, and Neurodegeneration—Neuroprotection by What You Eat! Molecular Neurobiology, 48[2],353–362. https://doi.org/10.1007/s12035-013-8498-3
19. Bae, J.-H., Bassenge, E., Kim, K.-B., Kim, Y.-N., Kim, K.-S., Lee, H.-J., Moon, K.-C., Lee, M.-S., Park, K.-Y., & Schwemmer, M. [2001]. Postprandial hypertriglyceridemia impairs endothelial function by enhanced oxidant stress. Atherosclerosis, 155[2], 517–523. https://doi.org/10.1016/S0021-9150[00]00601-8
20. Domínguez, R., Cuenca, E., Maté-Muñoz, J., García-Fernández, P., Serra-Paya, N., Estevan, M., Herreros, P., & Garnacho-Castaño, M. [2017]. Effects of Beetroot Juice Supplementation on Cardiorespiratory Endurance in Athletes. A Systematic Review. Nutrients, 9[1], 43. https://doi.org/10.3390/nu9010043
21. Barnard, N. D., Goldman, D. M., Loomis, J. F., Kahleova, H., Levin, S. M., Neabore, S., & Batts, T. C. [2019]. Plant-Based Diets for Cardiovascular Safety and Performance in Endurance Sports. Nutrients, 11[1], 130. https://doi.org/10.3390/nu11010130
22. Erridge, C., Attina, T., Spickett, C. M., & Webb, D. J. [2007]. A high-fat meal induces low-grade endotoxemia: Evidence of a novel mechanism of postprandial inflammation. The American Journal of Clinical Nutrition, 86[5], 1286–1292. https://doi.org/10.1093/ajcn/86.5.1286
23. Harte, A. L., Varma, M. C., Tripathi, G., McGee, K. C., Al-Daghri, N. M., Al-Attas, O. S., Sabico, S., O’Hare, J. P., Ceriello, A., Saravanan, P., Kumar, S., & McTernan, P. G. [2012]. High fat intake leads to acute postprandial exposure to circulating endotoxin in type 2 diabetic subjects. Diabetes Care, 35[2], 375–382. https://doi.org/10.2337/dc11-1593
24. Hever, J. [2016]. Plant-Based Diets: A Physician’s Guide. The Permanente Journal, 20[3], 15–082. https://doi.org/10.7812/TPP/15-082
25. de la Monte, S. M., & Tong, M. [2009]. Mechanisms of nitrosamine-mediated neurodegeneration: Potential relevance to sporadic Alzheimer’s disease. Journal of Alzheimer’s Disease: JAD, 17[4], 817–825. https://doi.org/10.3233/JAD-2009-1098
26. Ricker, M. A., & Haas, W. C. [2017]. Anti-Inflammatory Diet in Clinical Practice: A Review. Nutrition in Clinical Practice, 32[3], 318–325. https://doi.org/10.1177/0884533617700353
27. Carlsen, M. H., Halvorsen, B. L., Holte, K., Bøhn, S. K., Dragland, S., Sampson, L., Willey, C., Senoo, H., Umezono, Y., Sanada, C., Barikmo, I., Berhe, N., Willett, W. C., Phillips, K. M., Jacobs, D. R., & Blomhoff, R. [2010]. The total antioxidant content of more than 3100 foods, beverages, spices, herbs and supplements used worldwide. Nutrition Journal, 9, 3. https://doi.org/10.1186/1475-2891-9-3
28. Sutliffe, J. T., Wilson, L. D., de Heer, H. D., Foster, R. L., & Carnot, M. J. [2015]. C-reactive protein response to a vegan lifestyle intervention. Complementary Therapies in Medicine, 23[1], 32–37. https://doi.org/10.1016/j.ctim.2014.11.001
29. Carragee, E. J., Mitsunaga, K. A., Hurwitz, E. L., & Scuderi, G. J. [2011]. Retrograde ejaculation after anterior lumbar interbody fusion using rhBMP-2: A cohort controlled study. The Spine Journal: Official Journal of the North American Spine Society, 11[6], 511–516. https://doi.org/10.1016/j.spinee.2011.02.013
30. Thatikunta, P., Chakder, S., & Rattan, S. [1993]. Nitric oxide synthase inhibitor inhibits catecholamines release caused by hypogastric sympathetic nerve stimulation. The Journal of Pharmacology and Experimental Therapeutics, 267[3], 1363–1368.
31. Wu, G., Meininger, C. J., McNeal, C. J., Bazer, F. W., & Rhoads, J. M. [2021]. Role of L-Arginine in Nitric Oxide Synthesis and Health in Humans. Advances in Experimental Medicine and Biology, 1332, 167–187. https://doi.org/10.1007/978-3-030-74180-8_10