A procedure to establish feeling in the penis for men聽with spina bifida was performed for the first time in the United States in Seattle.
Tony Avellino, UW professor of neurological surgery, and Thomas Lendvay, a UW associate professor of pediatric urology聽who practices at Seattle Children鈥檚 Hospital, led the surgical team.
鈥淭his is truly an innovative procedure for either spina bifida patients or patients with lower-level spinal-cord injury who have sensation in the groin but not the penis,鈥� said Avellino.
Lendvay noted that, 鈥淏ased on the positive results of the first two patients, this new procedure has the potential to greatly improve the quality of life in our spina bifida adult and adolescent patients.鈥�
People with spinal bifida were born with an incomplete closure of their backbone, often because the neural tube didn鈥檛 form correctly during early embryonic development. Even when the spine is surgically closed after birth, the spinal cord in the affected section may not work properly in conducting nerve impulses. The patient may have a combination of nerve function and loss. They may have paralysis or numbness in only some parts of their body, for example.
The new operation is known as “Tomax” (for TO MAX-imize sensation, sexuality and quality of life). The procedure entails transferring a branch of the nerve supplying sensation from the thigh skin to the main skin sensation nerve to the penis. The successful completion of the procedure allows men with spinal cord impairment to feel sensation in a previously insensitive penis and improve sexual health.
Max Overgoor聽from the University of Utrecht in聽The Netherlands had performed 18 successful operations when David Shurtleff, UW professor of pediatrics, invited him to Seattle to聽observe聽the first U.S. operation of this nature.
Lendvay聽and Avellino聽performed the procedure at Seattle Children’s Hospital in March 2009. Their first U.S. patient was a 19-year-old聽college student. At a recent follow-up appointment,聽the young man reported having erogenous penile skin sensation and enhanced sexuality over the course of 聽the past 18 months.
He said: 鈥淏efore the surgery, I had no sensation at all. I found that sex was very frustrating and unsatisfying. Today, I have very good sensation. 鈥� I feel like a gained a body part that I was previously missing.鈥�
Avellino and Lendvay performed two procedures (at Harborview Medical Center and UW Medical Center) on another patient who also experienced erogenous sensation where he had never before felt anything.聽This man reported, 鈥淚t continues to improve my quality of life and makes me feel like I have a much more normal and complete body.鈥�
Avellino said the success of this pioneering procedure is due to a truly multidisciplinary effort. 鈥淲e can do innovative things here because we have experts from different specialties collaborating as a team. Pediatricians, spina bifida specialists, urologists and neurosurgeons 鈥� all working together.鈥�
Lendvay added, 鈥淲e are planning to collaborate with our Rehabilitation Medicine colleagues to expand this surgical opportunity to patients with traumatic spinal cord injury.聽 We also hope to explore the role such surgery may have in female patients with spinal cord lesions.鈥�
In October, Lendvay presented one of the surgical videos at the American Academy of Pediatrics meeting in New Orleans during the 鈥淚nnovative Procedures in Pediatric Urology鈥� panel. Avellino and Lendvay聽have submitted聽a video of the聽most recent procedure to the American Urological Association annual meeting, which will be held May 4鈥�8, 2013, in San Diego, Calif.
For more information about the procedure, read Overgoor鈥檚 , “Increased Sexual Health After Restored Genital Sensation in Male Patients with Spina Bifida or a Spinal Cord Injury: the TOMAX Procedure.”