Walking-Evoked Erection in Patients with Lumbar Degenerative Diseases: Eight Cases and Review of the Literature

Abstract

The purpose of this study was to evaluate the pathogenesis and outcome of therapy for walking-evoked erection in patients with lumbar degenerative diseases. Overview of Literature: Cauda equina compression due to lumbar degenerative diseases rarely cause a walking-evoked erection; however, no review has been undertaken of walking-evoked erection in patients with lumbar degenerative diseases. Methods: A total of 1,570 male patients with lumbar degenerative diseases, who underwent surgery between April 2003 and June 2017, were evaluated; from these patients, participants with walking-evoked erection were selected. Preoperative clinical data of walking-evoked erection, paresthesia, and bladder and bowel function were assessed. In our study, the neurological status and the erectile function of each participant were retrospectively evaluated before and after surgery using the Japanese Orthopedic Association score and the Overactive Bladder Symptom Score. Results: Among the 1,570 male patients screened in our department, eight patients (0.51%, 8/1,570) presented with walking-evoked erection accompanied by cauda equina symptoms. In six of the patients, the erectile symptoms were associated with paresthesia in the genitalia or perianal region. Of the six patients evaluated for bladder dysfunction, all were diagnosed with prostatic hyperplasia, while four were diagnosed with an overactive bladder. In all patients, walking-evoked erection disappeared entirely after surgery. Conclusions: This study comprises the first review of walking-evoked erection in patients with lumbar degenerative diseases. We speculate that sensory input, such as paresthesia in the genitalia or perianal region stimulates the pelvic or perineal nerves through the pudendal nerve and induces reflexogenic erections.

Lumbar Spinal Stenosis: Review Update 2022

“…To identify blood flow obstructions and rule out lower-extremity edema and varicose veins, the dorsum of the foot and popliteal artery should be palpated [19]. Furthermore, it should be separated from signs of lesions in the lower extremities, such as hip and knee lesions [3,[20][21][22][23][24]. Some provocative tests, such as the walking, fall-related, and handgrip strength tests, can also be employed to assess the current and postoperative status of patients with LSS [25][26][27][28][29][30].…”

“…It is difficult to predict the likelihood of recovery after surgery, even when uncommon long-term motor paralysis is the main symptom; thus, other causes should be identified prior to surgery. Rapidly developing neurological abnormalities or the lack of urine and feces necessitate early decompression [11,21,46]. When deciding whether to undergo surgery, abnormal findings on CT or MRI imaging should correlate to the patient's complaints [22].…”