Clinical efficacy and impact on sexual function of percutaneous endoscopic lumbar discectomy in the treatment of male lumbar disc herniation complicated with cauda equina syndrome

To investigate the surgical efficacy of Percutaneous Endoscopic Lumbar Discectomy (PELD) versus Interlaminar Fenestration Decompression (IFD) in treating male patients with Lumbar Disc Herniation (LDH) complicated with Cauda Equina Syndrome (CES), and to evaluate their impact on sexual function. A retrospective analysis was conducted on male patients with LDH complicated with CES who underwent PELD or IFD at Shenzhen Traditional Chinese Medicine Hospital from January 2014 to December 2022. The patients were divided into PELD group and IFD group based on the surgical procedure. Surgical efficacy was assessed using Visual Analogue Scale (VAS), Japanese Orthopaedic Association (JOA) score, and Oswestry Disability Index (ODI). Sexual function was evaluated using the International Index of Erectile Function-5 (IIEF-5), Premature Ejaculation Diagnostic Tool (PEDT), and the International Spinal Cord Injury Male Sexual Function Basic Data Set. A total of 98 patients were included (47 in the PELD group and 51 in the IFD group). Perioperative Indicators: The PELD group showed significant advantages over the IFD group in intraoperative blood loss (15.84 ± 5.31 ml vs. 42.56 ± 12.79 ml, P < 0.001), incision length (0.74 ± 0.17 cm vs. 4.53 ± 0.81 cm, P < 0.001), and time to ambulation (24.52 ± 6.28 h vs. 46.84 ± 10.57 h, P < 0.001), and did not require drainage. Clinical Efficacy: At 1 month postoperatively, the PELD group had lower low back pain and leg pain VAS scores (3.12 ± 1.24/3.57 ± 1.36 vs. IFD group), higher JOA scores (15.84 ± 2.81), and lower ODI indices (35.57 ± 5.81%) (P < 0.05). There was no significant difference in pain and function scores between the two groups at 2 years postoperatively (P > 0.05). Impact on Sexual Function: At 3 months postoperatively, the PELD group had significantly higher IIEF-5 scores (15.88 ± 3.21), psychogenic erection normal rate (38.30%), and orgasm normal rate (40.43%) than the IFD group (P < 0.05). Sexual function recovered to similar levels in both groups at 2 years postoperatively (IIEF-5 score > 20, P > 0.05). PELD demonstrates advantages of minimal trauma, faster early pain relief, and quicker functional recovery compared with IFD in the treatment of LDH complicated with CES, and exerts more significant early protective effects on male sexual function, while the long-term efficacy is comparable between the two procedures. This technique can be an option for male CES patients seeking rapid recovery and sexual function protection.