ALIF in a Spanish female cohort: No urinary and sexual complications or a gender bias?

Abstract

Background: The objective of the present study is to analyze urinary and sexual functions in females treated with ALIF and to describe possible complications not previously reported in the literature.

Methods: We conducted a retrospective study of urinary and sexual functions in females treated with this technique in our hospital between 2019 and 2022. Inclusion criteria were: females treated with ALIF with informed consent.

Results: 22 patients consented to participate. The median age was 51.5 years, the median follow-up was 11.5 months, and there was an improvement in low back pain of 4 points on the postoperative (postop) visual analogue scale (VAS). Overall, 36.3% of patients reported postoperative urinary deterioration, including 27.3% with new-onset urinary incontinence. The international consultation on incontinence questionnaire-short form score worsened by 3.5 points. 77.2% maintained an active sexual life; within this group, there was a worsening of 2.4 points in the postop female sexual function index and 35.2% described worsening in sexual function. We hypothesized that age, underlying lumbar pathology and changes in postoperative VAS scores could be confounding factors; however, only the relationship between age and postoperative urinary deterioration reached statistical significance (p = 0.034).

Conclusions: The present study describes deterioration in urinary function in 36.3% and in sexual function in 35.2% after the procedure, findings also supported by specific scales. In view of the above, we cannot discount a possible gender bias in the literature. Despite that, we believe that ALIF is still an adequate technique, but studies of higher level of evidence should be conducted to improve the information process of our patients.