Intermittent penile erection in lumbar spinal stenosis: Report of four new cases and review.

BACKGROUND: Lumbar spinal stenosis (LSS) classically presents with intermittent neurogenic claudication. Rarely, however, it may cause unanticipated, unpleasant, involuntary, and transient penile erections without sexual stimulation along with urinary urgency and claudication. CASE DESCRIPTION: The authors present four males with LSS whose principal symptoms were intermittent neurogenic claudication and unanticipated erections while walking, accompanied by urinary urgency.
CONCLUSION: There is scant literature on the topic of LSS presenting with unanticipated penile erections, urinary urgency, and neurogenic claudication. Copyright:

INTRODUCTION

Lumbar spinal stenosis (LSS) is typically characterized by intermittent neurogenic claudication on ambulation. However, in males, it may also rarely be accompanied by unanticipated, intermittent penile erections (e.g., that lasts as long as the patient ambulates, in the absence of sexual stimulation) with urinary urgency. Here, we describe our experience with four such patients, along with a review of 17 similar cases published in literature.[1,3-14]

CASE DESCRIPTION

From 2012 to 2018, four patients with lumbar stenosis presented with intermittent neurogenic claudication associated with intermittent involuntary penile erections after walking between 50 and 200 m accompanied by urinary urgency. The age of the patients ranged from 53 to 63. Patients had these symptoms for between 18 months and 4 years. All four patients had multilevel LSS. Two patients were successfully managed with decompressive laminectomies [Figures 1 and 2]. The remaining two cases involved two biological brothers who both declined surgical interventions [Table 1].

Figure 1:

(a) Lateral lumbar spine radiograph, (b and c) T2- and T1-weighted sagittal magnetic resonance imaging of the lumbar region showing lumbar canal stenosis. (d) T2-weighted axial images showing marked stenosis.

Figure 2:

(a) T2-weighted sagittal lumbar spine magnetic resonance imaging (MRI) and (b) T2-weighted axial MRI both showing multilevel lumbar canal stenosis.

Table 1:

Patients’ information about age, sex, and type of management.

DISCUSSION

Rarely, male patients with LSS and intermittent neurogenic claudication additionally develop intermittent priapism and urinary urgency, relieved on sitting down or by bending forward.[1,3-11,13,14]

Pathogenesis of intermittent penile erection

LSS can cause erections by altering the balance of sympathetic and parasympathetic discharges from the spinal cord or cauda equina.[11-14] In 2005, Tubbs et al. described an achondroplastic patient who had intermittent penile erections secondary to LSS.[12] Valsalva maneuver-induced priapism was also reported by Chen et al., in a patient with a lumbar extradural arachnoid cyst.[2] Appropriate decompressive surgery was recommended to treat this constellation of symptoms.[1,3-11,13,14]

CONCLUSION

For males with LSS, the additional development of transient, painful, involuntary penile erections, without sexual stimulation, accompanied by urinary urgency may be effectively relieved with decompressive spinal surgery.