title: Restoring tactile and erogenous penile sensation in low-spinal-lesion patients: procedural and technical aspects following 43 TOMAX nerve transfer procedures.
abstract: BACKGROUND
  The "TOMAX" (TO MAX-imize sensation, sexuality, and quality of life) procedure restores genital sensation in men with low spinal lesions, improving sexual health, as shown previously. It connects the dorsal nerve of the penis to the intact ipsilateral ilioinguinal nerve, unilaterally or bilaterally. This study reports on the technical aspects based on 43 TOMAX nerve transfers.
  
  
  METHODS
  In 40 patients with no penile but intact groin sensation, 43 nerve transfers were performed. Data on patient selection, surgical history, anatomy of the ilioinguinal nerve and dorsal nerve of the penis, unilateral or bilateral surgery, surgical technique, complications, and patient information were collected prospectively.
  
  
  RESULTS
  Regardless of origin, all patients with no penile but good groin sensation are eligible for the procedure, provided the ilioinguinal nerve is not damaged because of former inguinal surgery or absent because of anatomical variations. Selection of a unilateral or bilateral procedure depends on the presence or absence of reflex erections and bulbocavernosus reflex. Preliminary experience with the first three bilateral cases shows that it is technically feasible, with encouraging results. The surgical technique has evolved (described in detail, including video) to enhance outcome and reduce complications. Patients are better informed, resulting in realistic expectations.
  
  
  CONCLUSIONS
  This article synthesizes the procedural and technical experience of 43 TOMAX nerve transfers. Anyone skilled in peripheral nerve surgery and microsurgery can adopt this concept and further develop it. The TOMAX procedure can then be used to restore erogenous penile sensation and improve the quality of sexual health in patients with absent penile but good groin sensation.
authors: Zwolle and Utrecht, The Netherlands From the Department of Plastic, Reconstructive and Hand Surgery, Isala Clinic, Sophia Site; Pediatric Renal Center, Department of Pediatric Urology, University Children's Hospital, UMC Utrecht and AMC Amsterdam; and the Division of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht.
authors: Max L E
authors: MLE
authors: Overgoor
authors: Tom P V M
authors: TPVM
authors: de Jong
authors: Moshe
authors: M
authors: Kon
mesh_terms: D000328:Adult; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D016067:Nerve Transfer / Q000379:methods*; D010409:Penile Diseases / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D010410:Penile Erection; D010413:Penis / Q000294:innervation / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D060525:Pudendal Nerve / Q000601:surgery*; D012677:Sensation; D012735:Sexual Dysfunction, Physiological / Q000209:etiology / Q000601:surgery*; D013119:Spinal Cord Injuries / Q000150:complications*; D016135:Spinal Dysraphism / Q000150:complications; D016896:Treatment Outcome