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.
OBJECTIVE
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.
Department of Plastic, Reconstructive and Hand Surgery, Isala Clinics, Zwolle, The Netherlands.
Max L E
ML
Overgoor
Jan P
JP
Braakhekke
Moshe
M
Kon
Tom P V M
TP
De Jong
D000293:Adolescent; D000328:Adult; D004576:Electromyography; D006801:Humans; D008297:Male; D008875:Middle Aged; D010409:Penile Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D010410:Penile Erection; D010413:Penis / Q000294:innervation*; D060525:Pudendal Nerve / Q000503:physiopathology / Q000601:surgery*; D011788:Quality of Life; D020127:Recovery of Function; D012021:Reflex, Abnormal; D012684:Sensory Thresholds; D013119:Spinal Cord Injuries / Q000150:complications*; D016135:Spinal Dysraphism / Q000150:complications*; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult
TOMAX; bulbocavernosus reflex; dorsal nerve of penis; glans penis; penile sensation; reflex erection; spina bifida; spinal cord injury