Neurological bypass for sensory innervation of the penis in patients with spina bifida and traumatic spinal lesion

Abstract

Purpose Restoration of sensation in the penis may contribute importantly to quality of life of spina bifida (SB) and traumatic spinal lesion (TSL) patients. The aim of this prospective study was to investigate the outcome of a new operative neurological bypass procedure. Material and methods Twenty-four patients (17 SB and 7 TSL, 13-42 yrs, spinal lesion below L1) with no sensation of their glans-penis but good sensation in the groin area were selected. The sensory ilioinguinal nerve (L1) was cut distally in the groin and anastomosed by microneurorraphy to the ipsilateral dorsal nerve of the penis, (S2-4). All patients had pre and postoperative neurological and psychological evaluations. Results Twelve months postoperatively, 21 patients gained excellent sensation in the glans, which was first experienced “as if the groin was being touched”. In 8 patients this “groin” sensation transformed into “glans-penis sensation” and gained erogenous quality resulting in more meaningful and -frequent masturbation and sexual activities. All were unequivocally positive about the results and their penis had become more integrated in their body image. Conclusions The neurological bypass procedure in low spinal lesion patients resulted in excellent tactile- and in one third of the patients erogenous sensibility in the glans penis. The new sensation appeared to contribute to the quality of the patients' sexuality, sexual functioning, and their quality of life. This new operation might become standard treatment for low spinal lesion patients in the future.