Restoring penis sensation in patients with low spinal cord lesions: The role of the remaining function of the dorsal nerve in a unilateral or bilateral TOMAX procedure
2014; Wiley; Volume: 34; Issue: 4 Linguagem: Inglês
10.1002/nau.22566
ISSN1520-6777
AutoresMax L. E. Overgoor, J.P. Braakhekke, Moshe Kon, Tom P.V.M. de Jong,
Tópico(s)Nerve Injury and Rehabilitation
ResumoNeurourology and UrodynamicsVolume 34, Issue 4 p. 343-348 Clinical Science Restoring penis sensation in patients with low spinal cord lesions: The role of the remaining function of the dorsal nerve in a unilateral or bilateral TOMAX procedure Max L.E. Overgoor, Corresponding Author Max L.E. Overgoor Department of Plastic, Reconstructive and Hand Surgery, Isala Clinics, Zwolle, The NetherlandsCorrespondence to: Max L.E. Overgoor, M.D., Department of Plastic, Reconstructive and Hand Surgery, Isala Clinics, Sophia Site, P.O. Box 10400, 8000 GK Zwolle, The Netherlands. E-mail: [email protected]Search for more papers by this authorJan P. Braakhekke, Jan P. Braakhekke Department of Neurology and Clinical Neurophysiology, Isala Clinics, Zwolle, The NetherlandsSearch for more papers by this authorMoshe Kon, Moshe Kon Division of Plastic, Reconstructive and Hand Surgery, University Medical Centre, Utrecht, The NetherlandsSearch for more papers by this authorTom P.V.M. De Jong, Tom P.V.M. De Jong Paediatric Renal Centre, Department of Paediatric Urology, University Children's Hospital, UMC Utrecht and AMC Amsterdam, The NetherlandsSearch for more papers by this author Max L.E. Overgoor, Corresponding Author Max L.E. Overgoor Department of Plastic, Reconstructive and Hand Surgery, Isala Clinics, Zwolle, The NetherlandsCorrespondence to: Max L.E. Overgoor, M.D., Department of Plastic, Reconstructive and Hand Surgery, Isala Clinics, Sophia Site, P.O. Box 10400, 8000 GK Zwolle, The Netherlands. E-mail: [email protected]Search for more papers by this authorJan P. Braakhekke, Jan P. Braakhekke Department of Neurology and Clinical Neurophysiology, Isala Clinics, Zwolle, The NetherlandsSearch for more papers by this authorMoshe Kon, Moshe Kon Division of Plastic, Reconstructive and Hand Surgery, University Medical Centre, Utrecht, The NetherlandsSearch for more papers by this authorTom P.V.M. De Jong, Tom P.V.M. De Jong Paediatric Renal Centre, Department of Paediatric Urology, University Children's Hospital, UMC Utrecht and AMC Amsterdam, The NetherlandsSearch for more papers by this author First published: 30 January 2014 https://doi.org/10.1002/nau.22566Citations: 11 Conflict of interest: none. Mickey Karram led the peer-review process as the Associate Editor responsible for the paper. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat Abstract Aims: The recently developed TOMAX-procedure restores unilateral genital sensation, improving sexual health in men with a low spinal lesion (LSL). It connects one dorsal nerve of the penis (DNP) to the intact ipsilateral ilioinguinal nerve. We proposed bilateral neurotization for full sensation of the glans but this entails cutting both DNPs, risking patients' erection/ejaculation ability. The objective was to select patients for a bilateral TOMAX-procedure by measuring remaining DNP function, and perform the first bilateral cases. Methods In 30 LSL patients with no penile- but normal groin sensation selected for a unilateral TOMAX-procedure the integrity of the sacral-reflex-arc and DNP function was tested pre-operatively using bilateral needle electromyography (EMG)–bulbocavernosus reflex (BCR) measurements, and an interview about reflex erections (RE) ability. Results In 13 spina bifida- and 17 spinal cord injury patients [median age 29.5 years (range 13–59 years), spinal lesion T12 (incomplete) to sacral], seven (23%) patients reported RE, four (57%) with intact BCR, and of nine (30%) patients with intact BCR, four reported RE (44%). Conclusions Even patients with a LSL and no penile sensation can have signs of remaining DNP function, but cutting both DNPs to restore full glans sensation in a bilateral TOMAX-procedure might interfere with their RE/ejaculation. To avoid this risk, we propose a selecting-protocol for a unilateral- or bilateral procedure using RE and BCR measurements. Using this protocol, three patients were bilaterally operated with promising preliminary results. Full sensation of the glans could lead to further improvement in sexual function. Neurourol. Urodynam. 34:343–348, 2015. © 2014 Wiley Periodicals, Inc. REFERENCES 1 Overgoor ML, de Jong TP, Cohen-Kettenis PT, et al. 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