Location
Philadelphia, PA
Start Date
8-5-2019 1:00 PM
End Date
8-5-2019 4:00 PM
Description
Purpose: Loss of penis sensation or development of a painful penis can occur after injury to the dorsal branch of the pudendal nerve. Attempted relief of this problem through neurolysis of the dorsal nerve in the inferior pubic ramus canal has been reported rarely. While recovery of genital sensibility has been discussed frequently in transmen, this subject has been reported rarely in cismen. The purpose of this report is to review our experience with recovery of sensation after decompression of the dorsal branch of the pudendal nerve.
Methods: A retrospective chart review was carried out from 2014 to 2018, of cismen who have had decompression of the dorsal branch of the pudendal nerve bilaterally. Patients were included if there was a thorough Urologic evaluation for sources of penile pain other than pudendal nerve injury, trial of antibiotics if prostatitis was suspected, normal magnetic resonance imaging (MRI) of the pelvis, and underwent a successful pudendal nerve block if pain was part of the symptomatology. Patients were excluded if they had previous genital surgery. The changes in penile symptoms (erection, ejaculation, ejaculatory pain, erogenous sensation, numbness, pain) were evaluated post-operatively. Secondary measures included the mechanism of injury, mean length of penile symptoms, mean time to improvement of first symptom, symptom recurrence, post-operative complications, and mean follow-up time.
Results: Mechanisms of injury in this cohort of 8 men were 3 cycling (38%), 3 falls (38%) and 2 prostatectomy (28%). The mean length of penile symptoms prior to surgery was 254 weeks. Mean follow-up time was 9 weeks. Mean time to improvement in first symptom was 8 weeks. Of the 8 men included in this study, 6 (75%) had surgery bilaterally. Of the 3 men who had erectile dysfunction, normal erections were restored in 2 (67%) patients. Of the 2 patients unable to ejaculate, 1 (50%) patient regained ejaculatory function. Of the 5 patients with ejaculatory pain, complete relief of pain occurred in 3 (60%) patients, with partial relief in 2 (40%) patients. Of the 7 patients with loss of penile sensation, complete recovery of erogenous sensibility occurred in 6 (86%) patients, with partial relief in 1 (14%) patient. Of the 6 patients with penile pain, complete relief of pain occurred in 3 (50%) patients, with partial relief in 3 (50%) patients. Of the 4 patients with numbness, 1 (25%) patient had a complete return of feeling, with partial return in 3 (75%) patients.
Complications: one patient had relief of pain but some residual penile numbness.
Conclusions: Neurolysis of the dorsal nerve to the penis can be successful in relieving pain, restoring sensation and erectile function in cismen who sustained an injury along the inferior pubic ramus. This approach may prove useful to transmen who have scarring about the dorsal nerve after transgender surgery.
Embargo Period
5-28-2019
Restoration of Penile Sensation after Dorsal Nerve Trauma in Cismen
Philadelphia, PA
Purpose: Loss of penis sensation or development of a painful penis can occur after injury to the dorsal branch of the pudendal nerve. Attempted relief of this problem through neurolysis of the dorsal nerve in the inferior pubic ramus canal has been reported rarely. While recovery of genital sensibility has been discussed frequently in transmen, this subject has been reported rarely in cismen. The purpose of this report is to review our experience with recovery of sensation after decompression of the dorsal branch of the pudendal nerve.
Methods: A retrospective chart review was carried out from 2014 to 2018, of cismen who have had decompression of the dorsal branch of the pudendal nerve bilaterally. Patients were included if there was a thorough Urologic evaluation for sources of penile pain other than pudendal nerve injury, trial of antibiotics if prostatitis was suspected, normal magnetic resonance imaging (MRI) of the pelvis, and underwent a successful pudendal nerve block if pain was part of the symptomatology. Patients were excluded if they had previous genital surgery. The changes in penile symptoms (erection, ejaculation, ejaculatory pain, erogenous sensation, numbness, pain) were evaluated post-operatively. Secondary measures included the mechanism of injury, mean length of penile symptoms, mean time to improvement of first symptom, symptom recurrence, post-operative complications, and mean follow-up time.
Results: Mechanisms of injury in this cohort of 8 men were 3 cycling (38%), 3 falls (38%) and 2 prostatectomy (28%). The mean length of penile symptoms prior to surgery was 254 weeks. Mean follow-up time was 9 weeks. Mean time to improvement in first symptom was 8 weeks. Of the 8 men included in this study, 6 (75%) had surgery bilaterally. Of the 3 men who had erectile dysfunction, normal erections were restored in 2 (67%) patients. Of the 2 patients unable to ejaculate, 1 (50%) patient regained ejaculatory function. Of the 5 patients with ejaculatory pain, complete relief of pain occurred in 3 (60%) patients, with partial relief in 2 (40%) patients. Of the 7 patients with loss of penile sensation, complete recovery of erogenous sensibility occurred in 6 (86%) patients, with partial relief in 1 (14%) patient. Of the 6 patients with penile pain, complete relief of pain occurred in 3 (50%) patients, with partial relief in 3 (50%) patients. Of the 4 patients with numbness, 1 (25%) patient had a complete return of feeling, with partial return in 3 (75%) patients.
Complications: one patient had relief of pain but some residual penile numbness.
Conclusions: Neurolysis of the dorsal nerve to the penis can be successful in relieving pain, restoring sensation and erectile function in cismen who sustained an injury along the inferior pubic ramus. This approach may prove useful to transmen who have scarring about the dorsal nerve after transgender surgery.