BACKGROUND/OBJECTIVE: Tarlov cysts or spinal perineurial cysts are uncommon 
lesions. These are mostly incidental findings on magnetic resonance imaging or 
myelograms. The objectives of this study were to describe Tarlov cysts of the 
sacral region as a potential cause for retrograde ejaculations and review 
available management options.
METHODS: Case report and literature review.
RESULTS: A 28-year-old man presented with back pain and retrograde ejaculations 
resulting in infertility. After microsurgical excision of large perineurial 
cysts, back pain resolved, but semen quality showed only marginal improvement. 
Later, the couple successfully conceived by intrauterine insemination. To the 
best of our knowledge, this is the first reported case of Tarlov cyst associated 
with retrograde ejaculation and infertility.
CONCLUSIONS: Despite being mostly asymptomatic and an incidental finding, Tarlov 
cyst is an important clinical entity because of its tendency to increase in size 
with time. Tarlov cysts of the sacral and cauda equina region may be a rare 
underlying cause in otherwise unexplained retrograde ejaculations and 
infertility. Microsurgical excision may be a good option in a select group of 
patients.