Efficacy evaluation of sural nerve bridging transplantation for restoration of penis disturbance of sensation after selective dorsal nerve neurotomy_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SI Si , WANG Huaisheng , PU Yi ,  CEN Ying ,  XIAO Haitao

Department of Burns and Plastic Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding?author：

CEN Ying, Email: Cenying0141@163.com; XIAO Haitao, Email: xhaitao@163.com

Keywords：

Selective dorsal nerve neurotomy; sensation disturbance; nerve bridging transplantation; sural nerve

DOI：

10.7507/1002-1892.201611114

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Objective To evaluate the clinical effect of sural nerve bridging transplantation for the restoration of penis disturbance of sensation after selective dorsal nerve neurotomy. Methods Between May 2014 and May 2016, 23 patients underwent sural nerve bridging transplantation for the restoration of penis disturbance of sensation after selective dorsal nerve neurotomy. The age ranged from 19 to 38 years (mean, 27 years). The course of disease was 1-28 months (mean, 14 months). The defect length was 1.0-1.5 cm. Preoperative main neurological sign was sensory disturbance. The chief complaint of 21 patients was a erectile dysfunction; all had normal hormone levels, and there was no other organic diseases or surgical contraindication. According to the self-assessment lists of symptom-SCL90 evaluation, 19 cases had depression, 16 cases had anxiety, and 15 cases had both anxiety and depression; 3 cases had psychological abnormalities (social barriers, etc.). According to the functional neurological evaluation standard of British Medical Research Institute, the static two-point discrimination and sensation recovery standard rating were evaluated before and after operation; sexual pleasure obstacle sensitivity, temperature sense, and other subjective improvement were recorded. The International Index of Erectile Function 5 (IIEF-5) was used to evaluate questionnaire of the patient with erectile dysfunction before and after operation. The psychological state was accessed with the self-assessment lists of symptom-SCL90 evaluation after operation. Results All incisions healed by first intention. The mean follow-up time was 8 months (range, 6-12 months). Sexual pleasure obstacle was obviously improved in 11 cases, partially improved in 5 cases; the improvements in temperature and tactile sensitivity were achieved in 21 cases; no obvious improvement was observed in 1 case. The sensation recovery standard rating, static two-point discrimination and grade of IIEF-5 were significantly improved at 3 and 6 months after operation when compared with preoperative ones (P<0.05). At 6 months after operation, symptom was improved in 14 of 19 patients with depression (73.68%), in 12 of 16 patients with anxiety (75.00%), and in 12 of 15 patients with anxiety and depression(80.00%). Conclusion Sural nerve bridging transplantation is an effective method for the restoration of penis disturbance of sensation after selective dorsal nerve neurotomy.

Citation： SI Si, WANG Huaisheng, PU Yi, CEN Ying, XIAO Haitao. Efficacy evaluation of sural nerve bridging transplantation for restoration of penis disturbance of sensation after selective dorsal nerve neurotomy. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(6): 709-713. doi: 10.7507/1002-1892.201611114 Copy

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12.	Millesi H. Microsurgery of peripheral nerves. World J Surg, 1979, 3(1): 67-79, 128-129.
13.	唐舉玉, 俞芳, 吳攀峰, 等. 去細胞同種異體神經移植修復橈神經和指神經缺損六例. 中華顯微外科雜志, 2014, 37(5): 449-452.
14.	王源瑞, 張振軍, 冷永德, 等. 神經橋接與神經端側縫合修復周圍神經缺損的研究進展. 中華創傷骨科雜志, 2006, 8(11): 1072-1075.
15.	Millesi H. Techniques for nerve grafting. Hand Clin, 2000, 16(1): 73-91.
16.	李錦永, 胡洪良, 王換新, 等. 腓腸神經移植修復橈神經深支缺損的療效分析. 中華顯微外科雜志, 2013, 36(2): 183-185.
17.	王世煒, 劉松. 周圍神經損傷修復的研究進展. 中華神經外科雜志, 2014, 30(4): 419-422.
18.	崔殿生, 胡禮泉, 李世文, 等. 腓腸神經移植重建海綿體神經保留勃起功能的實驗研究. 中華男科學雜志, 2005, 10(5): 330-333.

1. Tullii RE, Ferreira R, Vaccari R. Neurotomy: a new thera-peuticechnique for primary premature ejaculation. Proceeding of the 4thAsia-Pacific Impotencea Meeting, 1993: 134-135.
2. Lee YS. Effect of dorsal nerve neurotomy in patients with premature ejaculation. Programme&Abstracts of China-Korea Medical Conference’97. 1997: 380.
3. 郭應祿. 陰莖勃起功能障礙. 北京: 北京醫科大學出版社, 1999: 58-59.
4. 鄧立文, 涂響安, 鄧春華, 等. 慢性前列腺炎患者性功能狀況與精神癥狀調查研究. 中國臨床實用醫學, 2007, 1(9): 5-7.
5. 薛珺, 汪靜宇, 陳利生, 等. 早泄的研究進展. 中華男科學雜志, 2007, 13(1): 65-68.
6. American Psychiatric Association. Diagnostic and statistical manual ofmental disorders. 4th eds. Text Revision. Washington DC: American Psychiatric Association, 2000: 68.
7. Montague DK, Jarow J, Broderick GA, et al. AUA guideline on thepharmacologic management of premature ejaculation. J Urol, 2004, 172(1): 290-294.
8. Althof SE, McMahon CG, Waldinger MD, et al. An update of the International Society of Sexual Medicine’s guidelines for the diagnosis and treatment of premature ejaculation (PE). J Sex Med, 2014, 11(6): 1392-1422.
9. Althof SE, Abdo CH, Dean J, et al. International Society for Sexual Medicine’s guidelines for the diagnosis and treatment of premature ejaculation. J Sex Med, 2010, 7(9): 2947-2969.
10. 孫中義, 李彥鋒, 周波, 等. 陰莖背神經選擇性切斷術提高陰莖感覺閾值的臨床分析. 中國男科學雜志, 2010, 24(10): 46-48.
11. 顧玉東. 周圍神經缺損的基本概念與治療原則. 中華手外科雜志, 2002, 18(3): 129-130.
12. Millesi H. Microsurgery of peripheral nerves. World J Surg, 1979, 3(1): 67-79, 128-129.
13. 唐舉玉, 俞芳, 吳攀峰, 等. 去細胞同種異體神經移植修復橈神經和指神經缺損六例. 中華顯微外科雜志, 2014, 37(5): 449-452.
14. 王源瑞, 張振軍, 冷永德, 等. 神經橋接與神經端側縫合修復周圍神經缺損的研究進展. 中華創傷骨科雜志, 2006, 8(11): 1072-1075.
15. Millesi H. Techniques for nerve grafting. Hand Clin, 2000, 16(1): 73-91.
16. 李錦永, 胡洪良, 王換新, 等. 腓腸神經移植修復橈神經深支缺損的療效分析. 中華顯微外科雜志, 2013, 36(2): 183-185.
17. 王世煒, 劉松. 周圍神經損傷修復的研究進展. 中華神經外科雜志, 2014, 30(4): 419-422.
18. 崔殿生, 胡禮泉, 李世文, 等. 腓腸神經移植重建海綿體神經保留勃起功能的實驗研究. 中華男科學雜志, 2005, 10(5): 330-333.

Chinese Journal of Reparative and Reconstructive Surgery

Efficacy evaluation of sural nerve bridging transplantation for restoration of penis disturbance of sensation after selective dorsal nerve neurotomy

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