Neurological bypass for sensory innervation of the penis in patients with spina bifida.
OBJECTIVE
Most male patients with spina bifida have normal sexual desires. During puberty they begin to realize that they can achieve erection and sexual intercourse but without any sensation in the penis. We hypothesized that restored sensation in the penis would greatly contribute to their quality of life and sexual health. In this prospective study we investigated the outcome of a new operative neurological bypass procedure in patients with spina bifida.


METHODS
In 3 patients who were 17, 18 and 21 years old with a spinal lesion at L5, L4 and L3-L4, respectively, the sensory ilioinguinal nerve (L1) was cut distal in the groin and joined by microneurorrhaphy to the divided ipsilateral dorsal nerve of the penis (S2-4) at the base of the penis. All patients underwent preoperative and postoperative neurological and psychological evaluations.


RESULTS
By 15 months postoperatively all patients had achieved excellent sensation on the operated side of the glans penis. They were unequivocally positive about the results and the penis had become more integrated into the body image. In 2 patients masturbation became more meaningful and 1 became more sexually active with and without his partner.


CONCLUSIONS
The newly designed neurological bypass procedure in patients with spina bifida resulted in excellent sensibility in the glans penis. The new sensation appeared to contribute to the quality of the patient sexuality and sexual functioning as well as to the feeling of being a more normal and complete individual who is more conscious of the penis. This new operation might become standard treatment in patients with spina bifida in the future.
Overgoor
Max L E
ML
Department of Plastic, Reconstructive and Hand Surgery, Isala Klinieken, loc. Sophia, 8000 GK Zwolle, The Netherlands.
Kon
Moshe
M
Cohen-Kettenis
Peggy T
PT
Strijbos
Saskia A M
SA
de Boer
Niels
N
de Jong
Tom P V M
TP
D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods; D010413:Penis / Q000294:innervation* / Q000601:surgery*; D011446:Prospective Studies; D012735:Sexual Dysfunction, Physiological / Q000209:etiology* / Q000601:surgery*; D020886:Somatosensory Disorders / Q000209:etiology* / Q000601:surgery*; D016135:Spinal Dysraphism / Q000150:complications*