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

Overgoor, Max L. E.; Braakhekke, J. P.; Kon, Moshe; Jong, Tom P.V.M. de

doi:10.1002/nau.22566

Cited by 15 publications

(5 citation statements)

References 26 publications

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“…Both of the patients reported a satisfactory recovery of penile sensation in the 2-year follow-up after surgery. One of the patients even accepted the contralateral surgery because of the encouraging results; similar requests also occurred in Overgoor's research (91,93,94).…”

Section: Medication Surgery and Other Treatmentssupporting

confidence: 65%

“…Firstly, this procedure requires the patient's injury segment to be lower than L1, and the proportion of these SCI patients is only about 5%, thus reducing the applicable scope for SCI (52). Secondly, due to the severance of the DNP, this procedure may impair the patient's residual reflex erection and ejaculation function, which is why the bilateral operation is considered cautiously (93). Furthermore, the treatment effect of this operation is still limited.…”

Section: Medication Surgery and Other Treatmentsmentioning

confidence: 99%

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Male genital sensation after spinal cord injury: a review

Zhang¹,

Li²

2020

Transl Androl Urol

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Genital sensation (GS) is an essential component of male sexual function. Genital sensory disturbance (GSD) caused by spinal cord injury (SCI) has a severe impact on the patients' sexual function but has garnered little research focus. Under normal conditions, GS encompasses the erection, ejaculation, sexual arousal, and orgasm courses associated with physiological and psychological responses in male sexual activity. However, in SCI patients, the deficiency of GS makes the tactile stimulation of the penis unable to cause sexual arousal, disturbs the normal processes of erection and ejaculation, and decreases sexual desire and satisfaction. To provide an overview of the contemporary conception and management of male GS after SCI, we review the innervation and sexual function of male GS in this article, discuss the effects of GSD following SCI, and summarize the current diagnosis and treatment of GSD in male SCI patients.

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Section: Medication Surgery and Other Treatmentssupporting

confidence: 65%

Section: Medication Surgery and Other Treatmentsmentioning

confidence: 99%

Male genital sensation after spinal cord injury: a review

Zhang¹,

Li²

2020

Transl Androl Urol

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“…An innovative method of enhancing sensation with regards to sexuality is the TOMAX procedure, involving a microsurgical connection between the ilioinguinal nerve and the dorsal penile nerve. While it clearly requires a special set of expertise it has been shown to be effective in a relevant proportion of patients [ 34 ].…”

Section: Specific Male Concerns On Anejaculation And/or Erectile Dysfunctionmentioning

confidence: 99%

Sexual function in adult patients who have undergone augmentation surgery in childhood: what is really important?

et al. 2020

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Problems relating to the development of a healthy approach to sex and intimacy during puberty, after augmentation cystoplasty, are scarcely discussed in literature. Therefore, this may suggest that such issues are insufficiently addressed by pediatric urologists. We gathered four experts in the field as well as an experienced leader of a patient group and mother of a girl with spina bifida and asked questions relevant to the following areas of care: (a) diversion, urinary incontinence, and sexual life; (b) impact of a stoma on body image perception and self-esteem; (c) specific female concerns with regard to fertility and recurrent urinary infections; (d) specific male concerns on anejaculation and erectile dysfunction. Their answers are discussed in view of the available literature. All experts and the patient group representative agreed that most of these patients will experience: lack of self-confidence as the most frequent obstacle to starting a relationship and incontinence as a barrier to sexual activity. The cosmesis of the stoma and abdominal scars might influence self-esteem and therefore the sexual activity, however it appears to be a less common concern in males than females. Our results outline the importance and influence that the body image, self-esteem, and confidence present for the individual expectations of the patients related to sex life and sexual activity. Physicians should be encouraged to ask all postpubertal patients about their sexual concerns at every visit. Further studies and exchange of information between clinicians are needed to provide meaningful and analyzable patient-related outcome measures (PROMs).

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“…(1) The pudendacavernosal reflex loop initiates reflexogenic erection: the dorsal nerve of the penis sends afferent sensory information to the sacral erection center S2-4, and the efferent cavernous nerves, through the pelvic nerve, initiate arterial vasodilatation in the erectile tissues of the penis leading to tumescence. (2) In the bulbocavernosus reflex loop, the dorsal nerve of the penis sends afferent sensory information from the penis to the sacral erection center S2-4, while efferent motor neurons travel via the pudendal nerve to the bulbocavernosus muscles [22]. The stimulus for reflexogenic erection comes from external sources such as rubbing paresthesia in the genitalia or perianal region.…”

Section: Pathogenesismentioning

confidence: 99%

Walking-Evoked Erection in Patients with Lumbar Degenerative Diseases: Eight Cases and Review of the Literature

et al. 2021

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The purpose of this study was to evaluate the pathogenesis and outcome of therapy for walking-evoked erection in patients with lumbar degenerative diseases. Overview of Literature: Cauda equina compression due to lumbar degenerative diseases rarely cause a walking-evoked erection; however, no review has been undertaken of walking-evoked erection in patients with lumbar degenerative diseases. Methods: A total of 1,570 male patients with lumbar degenerative diseases, who underwent surgery between April 2003 and June 2017, were evaluated; from these patients, participants with walking-evoked erection were selected. Preoperative clinical data of walking-evoked erection, paresthesia, and bladder and bowel function were assessed. In our study, the neurological status and the erectile function of each participant were retrospectively evaluated before and after surgery using the Japanese Orthopedic Association score and the Overactive Bladder Symptom Score. Results: Among the 1,570 male patients screened in our department, eight patients (0.51%, 8/1,570) presented with walking-evoked erection accompanied by cauda equina symptoms. In six of the patients, the erectile symptoms were associated with paresthesia in the genitalia or perianal region. Of the six patients evaluated for bladder dysfunction, all were diagnosed with prostatic hyperplasia, while four were diagnosed with an overactive bladder. In all patients, walking-evoked erection disappeared entirely after surgery. Conclusions: This study comprises the first review of walking-evoked erection in patients with lumbar degenerative diseases. We speculate that sensory input, such as paresthesia in the genitalia or perianal region stimulates the pelvic or perineal nerves through the pudendal nerve and induces reflexogenic erections.

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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

Cited by 15 publications

References 26 publications

Male genital sensation after spinal cord injury: a review

Male genital sensation after spinal cord injury: a review

Sexual function in adult patients who have undergone augmentation surgery in childhood: what is really important?

Walking-Evoked Erection in Patients with Lumbar Degenerative Diseases: Eight Cases and Review of the Literature

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