276 Korean J Pain Vol. 23, No. 4, 2010 ejaculation but without any further evaluation. As of now, his ejaculation has not returned during the 3 months period after the procedure. DISCUSSION NCPB is a commonly performed procedure in patients with intractable pain due to malignancies involving the up- per and mid abdomen [5]. Although its role in patients with benign abdominal pain has not been well established with controversies on whether it is truly effective for pain due to chronic pancreatitis, it is still recommended for patients who have exhausted all other treatment modalities [2]. One of the rare, but usually ignored complications of NCPB is sexual dysfunction [8]. Reports of ejaculatory fail- ure after celiac plexus block are very rare. One case was reported by Leung et al. [6] in a study of 23 patients with chronic pancreatitis and 13 patients with pancreatic cancer. The patient had developed impotence and hyper- esthesia of the lower limbs after a second block. Black and Dwyer [7] reported two cases of ejaculatory failure in a series of 100 patients who underwent celiac plexus block, and stated that it was a rare complaint due to the fact that most of the male patients selected were elderly. Whether the complication was resolved over time was not mentioned in either study. The normal ejaculation process is composed of three phases: seminal emission, bladder neck closure and ejacu- lation [9]. These three phases are under sympathetic α-adrenergic control of neurons, the cell bodies of which are located in the lateral columns of T11-L2, and para- sympathetic fibers of S2-4 [10]. The thoraco-lumbar spi- nal tract (T11-L2) appears to be responsible for the con- traction of smooth muscles of the prostate, seminal vesi- cle, the vas deferens, and partial bladder neck closure [11]. If sympathetic tone is completely abolished, no seminal emission will occur; if sympathetic tone is partially dis- rupted, it will lead to retrograde ejaculation. It is well known that there is a true risk of retrograde ejaculation after bilateral lumbar sympathetic blocks in male patients. Bilateral surgical sympathectomy is followed by disturbance of ejaculation in 13-54% of cases [12] but case reports are very rare with unilateral surgical lumbar sympathectomy or bilateral chemical sympathectomy. Baxter and O'Kafo [13] reported a case of ejaculatory fail- ure following bilateral phenol sympathectomy performed at L2-4, which eventually resolved after 5 weeks. Ishizaki et al. [12] reported two cases of ejaculatory failure after chemical sympathectomy; a case of absent seminal emis- sion after bilateral chemical sympathectomy of L2 and L3, and another case of retrograde ejaculation after unilateral chemical sympathectomy of L3. The former case did not resolve after 3 years of follow-up. However, the latter case was spontaneously changed to antegrade ejaculation after 2 years and 7 months. The patient of this case underwent a unilateral NCPB with 8 ml of 99% anhydrous ethyl alcohol. A unilateral NCPB was performed in this patient for two reasons. First, the patient's pain was dominant on the left side, and sec- ond, unilateral NCPB may have benefit in reducing the complications of neurolysis in a patient with benign ab- dominal pain [14]. Despite this precaution, ejaculatory fail- ure occurred in this patient and has not resolved after 3 months. Although he is being followed-up by an urologist, whether this patient's symptom is loss of seminal emission or retrograde ejaculation has not been determined. A post-masturbation urine specimen should be examined for sperm in order to accurately diagnose the type of disorder this patient is experiencing. Ejaculatory failure after NCPB may be attributed to spread of neurolytic agents to an unwanted region. In the case reported by Leung et al. [6], the authors used 25 ml of alcohol on each side for a bilateral NCPB in a patient with chronic pancreatitis. However, only 8 ml of alcohol was used for unilateral NCPB in our case. Other ex- planations may be variations in the dimension of the para- vertebral space leading to varying amount of neurolytic agent spread or abnormal sympathetic chain anatomy of the patient. Diminished or retrograde ejaculation, as well as ane- jaculation may occur in up to a third of male patients with diabetes [15]. In our case, the patient had been diagnosed with DM type 2 and was on medication for 5 years with random blood glucose levels ranging from 120 to 240 mg/dl. The patient was also taking zolpidem tartrate and trazodone due to depression and anxiety and alfuzosin due to benign prostatic hyperplasia, but these medications are not known to cause ejaculatory disorders. Although the history of DM with poorly controlled blood glucose levels may be a contributing factor to the patient's ejaculatory disorder, the fact that the symptoms developed dramati- cally after NCPB heightens the probability of it being a