Neuromodulación en aneyaculación. Reporte de caso y revisión de la literatura

Introduction and objectives: Sacral root neuromodulation (SRN) is a procedure used to treat urinary function, as well as bowel and sexual disorders. In sexual disorders, there is some data suggesting benefi ts in erectile dysfunction, with very little evidence on ejaculation disorders. The objective of this report is to review the theory of SRN operation and its indications in order to propose a hypothesis on the mechanism and why our patient improved his ejaculation disorder after the SRN procedure. We suggest the SRN as an alternative treatment in the management of refractory anejaculation. Methods and materials: Review of patient’s medical chart. A literature search was performed using MEDLINE and OVID. The search was limited to papers published in the last 10 years. MESH terms used were “sacral plexus”, “sacral region”, “ejaculation”, “neurobiology”, “spinal cord stimulation”, “transcutaneous electric nerve stimulation”, and also a non-MESH term “neuromodulation”. Results: We present the fi rst report of anejaculation, secondary to pelvic surgical dissection in a young patient with a previously normal sexual life. Ejaculation improved signifi cantly after the SRN procedure. The mechanism of action of SRN is not entirely known. It is possible that afferent electrical stimulation allows the modulation of spinal refl exes by restoring the balance between inhibition and activation at a central level. It has been used in the management of urinary, bowel, sexual, and nervous disorders. Based on this positive response, our hypothesis is that the surgical procedure altered the transmission of efferent signals of the pelvic nerves. The SRN procedure could improve the regulation of spinal refl exes and transmission of ejaculatory signals mediated by serotonin and noradrenaline transported by pelvic and pudenda nerves. Conclusions: The SRN is presented as an alternative in the management of anejaculation despite the lack of evidence to support the standardization of the procedure.