V1585: Ilioinguinal to Dorsal Penile Nerve Anastomosis
VideoIntroduction and Objectives
Penile skin sensation may be absent in patients with myelomeningocele due to poor pudendal nerve signaling. Here we describe the introduction of penile sensation via ilioinguinal to dorsal penile neuro-neurorrhaphy in two patients with penile anesthesia due to neural tube defects.
A 20-year-old Asian American male and a 35-year-old Caucasian male with L5/S1 myelomeningocele consented to this procedure after psychological evaluation. They were both high functioning, ambulatory, and had intact an ilioinguinal nerve sensation but anesthesia of the penis and glans. They were both sexually active, having penetrative intercourse, and were able to ejaculate antegrade. Both had pre-operative IIEF scores > 30.
An incision was made from anterior superior iliac crest to the base of the penis. The inguinal canal was opened and the ilioinguinal nerve was transected distally while the ipsilateral dorsal penile nerve was transected at the base of the penis. The nerves were anastomosed with 9-0 Prolene interrupted sutures in an epineurium-epineurium fashion. Both patients reported paresthesias of the groin with penile stimulation 1 month after the surgery and by 18 months, both patients experienced erogenous penile sensation during intercourse. Neither patient is having difficulty achieving or maintaining erections.
We present successful results of the first two patients to have undergone dorsal penile reinnervation via the ilioinguinal nerve in the United States. This procedure is safe and effective and may be offered to select patients with low spinal cord lesions from neural tube defects and potentially, spinal cord injuries.