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 effi cacy 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 fi rst 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 fi rst. 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
fi rst on whichever of the 2 structures has not yet
been ablated to carefully evaluate if RE will occur.
Key words: Retrograde ejaculation, superior
hypogastric plexus, ganglion impar; neurolysis,
chronic pelvic pain, male infertility, diagnostic
block
Superior Hypogastric Plexus Block for Chronic Pelvic Pain Through
an S1 Transforaminal Approach: A Case Report
