title: Reinnervating the penis in spina bifida patients in the United States: ilioinguinal-to-dorsal-penile neurorrhaphy in two cases.
abstract: BACKGROUND
  Penile sensation is absent in some patients with myelomeningocele owing to the dysfunction of the pudendal nerve. Here, we describe the introduction of penile sensation via ilioinguinal-to-dorsal-penile neurorrhaphy in two patients with penile anesthesia due to neural tube defects.
  
  
  OBJECTIVE
  To establish penile sensation via ilioinguinal-to-dorsal-penile-nerve neurorrhaphy.
  
  
  METHODS
  A 20-year-old and a 35-year-old male with L5/S1 myelomeningocele were both highly functioning and ambulatory, with intact ilioinguinal nerve distribution sensation but anesthesia of the penis and glans. They were sexually active and able to ejaculate antegrade. Both had high International Index of Erectile Function scores for confidence to achieve erection sufficient for intercourse. An incision was made from anterior superior iliac crest to the glans penis to expose the inguinal canal and ilioinguinal nerve. The ilioinguinal and dorsal penile nerve were transected and anastomosed. The anastomotic site was then wrapped in a hemostatic agent and a drain was left in place. For penile rehabilitation, both patients were instructed to stimulate the penis while looking at the genitalia to encourage redistribution of perceived sensation.
  
  
  METHODS
  Presence of erogenous penile sensation was tested by neurologic examination and patient feedback, and patients completed sexual health questionnaires.
  
  
  RESULTS
  Both patients reported paresthesias of the groin with penile stimulation 1 month after surgery. Both patients are now 24 months postoperative and have erogenous sensation on the ipsilateral glans and shaft during intercourse. Neither patient has 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, this is the first description of an attempt to resupply penile sensation via the dorsal penile nerve in the United States with a minimum of 18 months follow-up. Early follow-up suggests successful neuronal remapping and regained sensation of the penis.
authors.affiliation: Department of Urology, University of Texas, Southwestern, Dallas, TX, USA; Division of Pediatric Urology, Children's Medical Center Dallas, Dallas, TX, USA.
authors.forename: Micah A
authors.initials: MA
authors.lastname: Jacobs
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Avellino
authors.forename: David
authors.initials: D
authors.lastname: Shurtleff
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Lendvay
mesh_terms: D000328:Adult; D003075:Coitus; D004542:Ejaculation; D006801:Humans; D008297:Male; D009460:Neurologic Examination; D019635:Neurosurgical Procedures; D010410:Penile Erection; D010413:Penis / Q000294:innervation* / Q000503:physiopathology / Q000601:surgery*; D060525:Pudendal Nerve / Q000503:physiopathology / Q000601:surgery*; D020127:Recovery of Function; D012677:Sensation; D016135:Spinal Dysraphism / Q000503:physiopathology* / Q000523:psychology; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D013521:Urologic Surgical Procedures, Male; D055815:Young Adult
keywords: Genital Sensation; Ilioinguinal Nerve; Reinnervation; Spina Bifida; Spinal Cord Injury