1865 ILIOINGUINAL TO PENILE NEURO-NEURORRHAPHY IN THE MYELOMENINGOCELE PATIENT: PRESENTATION OF 2 CASES

Abstract

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Peyronie's Disease/Surgical Therapy II1 Apr 20121865 ILIOINGUINAL TO PENILE NEURO-NEURORRHAPHY IN THE MYELOMENINGOCELE PATIENT: PRESENTATION OF 2 CASES Micah Jacobs, Anthony Avellino, David Shurtleff, and Thomas Lendvay Micah JacobsMicah Jacobs Dallas, TX More articles by this author , Anthony AvellinoAnthony Avellino Seattle, WA More articles by this author , David ShurtleffDavid Shurtleff Seattle, WA More articles by this author , and Thomas LendvayThomas Lendvay Seattle, WA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1977AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Penile sensation may be absent in patients with myelomeningocele due to the dysfunction of the pudendal nerve distribution which supplies the dorsal penile nerve. Here we describe the introduction of penile sensation via ilioinguinal to dorsal penile neuro-neurorrhaphy in two patients with penile anesthesia due to neural tube defects. METHODS A 20-year-old Asian American male and a 35-year-old Caucasian male with L5/S1 myelomeningocele consented to this procedure after psychological evaluation. They were both highly functioning and ambulatory with intact ilioinguinal nerve distribution sensation but anesthesia of the penis and glans. They were both sexually active, having penetrative intercourse, and were able to ejaculate antegrade. Both have high IIEF scores for confidence to achieve erection and ability to achieve an erection sufficient for penetrative intercourse. PROCEDURE An incision was made from anterior superior iliac crest to the glans penis and carried to the external oblique fascia which was divided to expose the inguinal canal and ilioinguinal nerve. The ilioinguinal nerve was transected distally while the dorsal penile nerve was transected at the base of the ipsilateral penis.. The 2 nerves were anastomosed with 9-0 Prolene interrupted sutures in a tension free fashion. The anastomotic site was then wrapped in a hemostatic agent (polyanhydroglucuronic acid polymer) and covered in fibrin sealant. A suction drain is left in the subcutaneous space. For penile rehabilitation, both patients were instructed to stimulate the penis while looking at the region of the genitalia to encourage redistribution of perceived sensation. RESULTS Both patients reported paresthesias of the groin with penile stimulation 1 month after the surgery. Both patients are now 18 months out from the operation and are having erogenous sensation on the ipsilateral glans during intercourse. Neither patient is having difficulty achieving or maintaining erections. CONCLUSIONS We present two patients with dorsal penile reinnervation via the ilioinguinal nerve. Although nerve reinnervation has been used in urological procedures via sural nerve grafting of the dorsal cavernosal nerves, this is the first description of an attempt to resupply penile sensation via the dorsal penile nerve in the United States. Early follow-up suggests successful neuronal remapping and regained sensation of the penis. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byOvergoor M, de Jong T, Cohen-Kettenis P, Edens M and Kon M (2018) Increased Sexual Health After Restored Genital Sensation in Male Patients with Spina Bifida or a Spinal Cord Injury: the TOMAX ProcedureJournal of Urology, VOL. 189, NO. 2, (626-632), Online publication date: 1-Feb-2013. Volume 187Issue 4SApril 2012Page: e754 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Micah Jacobs Dallas, TX More articles by this author Anthony Avellino Seattle, WA More articles by this author David Shurtleff Seattle, WA More articles by this author Thomas Lendvay Seattle, WA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...