Purpose: Retrograde ejaculation after anterior approach for intersomatic L5-S1 arthrodesis is one of the most serious complications for young patients. The risk is related to the destruction of the hypogastric plexus during exposure of the lumbosacral segment. The rates reported in the literature vary from 0.42 to 5.9%. The purpose of this study was to compare the incidence of retrograde ejaculation in a prospective study of two groups of patients undergoing L5-S1 fusion via a trans-peritonial or retroperitoneal approach.

Material and methods: One hundred forty-six male patients underwent L5-S1 arthrodesis. Group A included 116 patients for whom a video-assisted retroperitoneal approach was used. Group B included 30 patients for whom a video-assisted transperitoneal approach was used. Patients were questioned concerning the presence or not of retrograde ejaculation at the preoperative examination then at 3, 6, and 24 months.

Results: Among the 146 patients, six exhibited retrograde ejaculation at three months. Two (1.72%) were in the retroperitoneal group (group A) and four (13.35) were in the transperitoneal group (group B). This difference was significant (Fisher test, p = 0.0015). Retrograde ejaculation regressed in two of these six patients at one year, one in group A and one in group B. At the end of the study with two years postoperative follow-up, four patients exhibited persistent retrograde ejaculation, one in group A (0.86%) and three in group B (10%). The difference was statistically significant (Fisher test, p = 0.025).

Discussion: This study provides to our knowledge the only prospective data available concerning the risk of retrograde ejaculation in patients undergoing anterior L5-S1 arthrodesis. The risk was significantly higher with the transperitoneal approach than the retroperitoneal approach (10% versus 0.86%).