Urogenital complications of anterior approaches to the lumbar spine.

The superior hypogastric plexus of the sympathetic nervous system is the only major innervation of the urogenital system which is normally at risk in anterior exposures of the lower lumbar spine. When this is injured, one can expect to see disturbances of urogenital function with retrograde ejaculation or sterility in males. Failure of penile erection is not anticipated unless the patient has, in addition, advanced peripheral vascular disease. The superior hypogastric plexus may be spared by careful dissection about the iliac arteries and lumbosacral junction or by approaching the spine laterally through a retroperitoneal exposure.