OBJECTIVETo investigate the mechanism of sensory nerve regeneration of the reconstructed penis with sensory nerve implantation and to explore a new surgical technique to improve the postoperative sensory function in phallic reconstruction.

METHODSAdult male New Zealand rabbits were randomly divided into experimental group (n = 20, with sensory nerve implantation) and control group (n = 20, without sensory nerve implantation), which were both performed phalloplasty with a superficial epigastric faciovascular pedicle flap. Postoperatively, the nerve regeneration process of the reconstructed penis was observed histologically.

RESULTSIn experimental group, the amount of CGRP positive nerve fibers increased markedly with the time prolonged, whereas merely a few CGRP positive fibers scattered in deep dermis 6 months later in the other group. The cutaneous sensory nerve regeneration of the reconstructed penis in experimental group shows the procedure that the myelinated axon began to exist within 3 months, thereafter the myelinated axon and unmyelinated axon were both observed under the electron microscope.

CONCLUSIONThese findings show that the rabbit model of phalloplasty with sensory nerve implantation can acquire well sensory reinnervation, and bring a light to clinical application for restoration of sensory function in reconstructed penis.

Animals ; Male ; Nerve Regeneration ; Penis ; innervation ; surgery ; Rabbits ; Surgical Flaps ; innervation

Neurogenic erectile dysfunction (NED) caused by pelvic floor surgeries/radiation therapies and associated with Parkinsons disease and diabetes remains a challenging healthcare issue. To facilitate NED research we have developed in vitro and in vivo experimental models. The in vitro model comprises the isolation, culture and treatment of rat major pelvic ganglia (MPG), which then produce outgrowing neurites whose length and molecular composition are indicative of the neurotrophic effect of the treatment agent. Through this approach we have confirmed that the brain-derived neurotrophic factor (BDNF) promotes nerve regeneration by activating the JAK/STAT signaling pathway. This has been further established by our in vivo model, which involves the transection or cruch of cavernous nerves and treatment with BDNF.
Animals ; Disease Models, Animal ; Erectile Dysfunction ; physiopathology ; Ganglia ; physiopathology ; Humans ; In Vitro Techniques ; Male ; Nerve Regeneration ; Pelvis ; innervation ; Penis ; innervation ; physiopathology

OBJECTIVETo trace the segmental distribution of somatic sensory neurons of the skin and dorsal nerve in the rabbitś penis.

METHODSThe experiment was performed on 8 adult male rabbits with the nerve tracing method of retrograde axonal transport of horseradish peroxidase (HRP), which was injected into the dermis around the penis and the dorsal nerve of the penis. The rabbits were sacrificed five days later to harvest the spinal cord segments and the dorsal root ganglia of lumbosacral segments for histological study.

RESULTSThe HRP tracing showed that a number of labeled HRP positive neurons appeared in spinal ganglia (S2 - S4) in all the rabbits, and distributed segmentally. The counts of the positive neurons different segments were: S2 (215.0 +/- 10.2) , S3 (242.2 +/- 8.3) and S4 (109.7 +/- 8.4) respectively, with statistically significant difference between the two groups.

CONCLUSIONThe rabbit's sensory nerve fibers in both the skin and the dorsal nerve of the penis are rooted in the S2-S4 segments of spinal ganglia, which distribute regularly.

Animals ; Anterior Horn Cells ; anatomy & histology ; Biomarkers ; Male ; Neurons, Afferent ; Neurons, Efferent ; Penis ; innervation ; Rabbits ; Random Allocation ; Skin ; innervation

BACKGROUNDBased on our clinical experience, the number of dorsal penile nerves in patients with primary premature ejaculation (PPE) is not consistent with the average number (2 branches). In this study, we evaluated the number and distribution of dorsal penile nerves among healthy Chinese adults and patients with PPE.

METHODSThe dorsal nerve of the penis, the deep dorsal vein of the penis, and the dorsal artery of the penis between the deep fascia of the penis and the albuginea penis were carefully educed, observed, and counted in 38 adult autopsy specimens. The number and distribution of the dorsal penile nerve in 128 surgical patients with PPE were determined.

RESULTSThe numbers of dorsal penile nerves of the 38 cases were as follows: 7 branches in 1 case; 6 branches in 1 case; 5 branches in 6 cases; 4 branches in 9 cases; 3 branches in 14 cases; and 2 branches in 7 cases. Most of the dorsal nerves were parallel to each other and in the dorsum of the penis. In only 8 cases, the branches were connected by some communicating branches. In 4 cases, 1 or 2 thin dorsal nerves continued their pathway over the ventral aspect of the penis. The average number of branches of the dorsal penile nerve in patients with PPE was 7.16.

CONCLUSIONSBased on the study of 38 cases, the average number of dorsal penile nerves was 3.55 branches and that of patients with PPE was greater. These preliminary results suggest that the excessive dorsal penile nerves may have an impact on PPE via increased sensitivity and provide topographic data for the possible treatment of PPE.

Adult ; Ejaculation ; Humans ; Male ; Middle Aged ; Penis ; innervation ; Sexual Dysfunction, Physiological ; pathology ; Young Adult

OBJECTIVETo evaluate the effect of elective microscopic resection of dorsal penile nerves in the treatment of primary premature ejaculation (PPE).

METHODSSeventy-eight PPE patients received elective microscopic resection of dorsal penile nerves, 5 branches in 9 cases, 6 in 17, 7 in 15, 8 in 14, 9 in 8, 10 in 6, 11 in 6, and 12 in 3. The patients were followed up for 12 months, and their intravaginal ejaculation latency time (IELT) and sexual intercourse satisfaction scores were recorded before and after treatment.

RESULTSCompared with the baseline, the IELT was significantly prolonged after surgery ([0.86 +/- 0.32] vs [6.65 +/- 3.9] min, P < 0.01), and the sexual intercourse satisfaction scores of the patients were dramatically increased (7.32 +/- 2.52 vs 12.32 +/- 3.76, P < 0.01), so were those of their sexual partners (4.46 +/- 1.36 vs 12.73 +/- 1.45, P < 0.01).

CONCLUSIONElective microscopic resection of dorsal penile nerves is safe and effective for the treatment of PPE.

Coitus ; Humans ; Male ; Patient Satisfaction ; Penis ; innervation ; Premature Ejaculation ; surgery ; Pudendal Nerve ; surgery

OBJECTIVETo reconstruct a penis with sensation and erectile function maintained by corpora cavernosa lengthening and skin flap transferring in the penis defect cases.

METHODSThe procedure was based on the use of releasing the suspensory ligaments and part of crus, various flaps were designed as coverage material. Penis residual stump was advanced to anterior portion of the newly reconstruction penile body as "glans".

RESULTS40 patients with penis defect have been operated by the above methods. In the cases, length of the penis varied from 0.5-4.0 cm in the flaccid, 1.5-5.0 cm in erect state before operation. And after operation, it turned to 5.0-8.5 cm in the flaccid, 7.0-12.5 cm in erect state. Most of the patients recovered gross tactile sensation and had satisfactory erectile function.

CONCLUSIONWith this method, the reconstructed penis tends to have a better appearance and function. It's a more optimal method compared with the conventional operation.

Adult ; Humans ; Male ; Penile Erection ; Penis ; injuries ; innervation ; surgery ; Reconstructive Surgical Procedures ; methods ; Sensation

OBJECTIVETo investigate the restoration of erectile function by reconstructing cavernous nerves with sural nerve grafts.

METHODSForty-eight male Sprague-Dawley rats(3-4 m old and 300-400 g) were randomly divided into three groups: the sham-operated group (n = 16) underwent pelvic exploration without transection of the cavernous nerve; the nerve ablation group (n = 16) had a 5 mm segment of the cavernous nerve excised bilaterally; the graft group (n = 16) had a 5 mm segment of the cavernous nerve excised bilaterally, followed by immediate microsurgical reconstruction with an interposition graft of the sural nerve. The cavernous nerves of each group were electrostimulated to determine their potency after 2 and 4 months. And fluorescent retrograde-transported material Fluoro-Gold(FG) was injected into the penis. FG-labeled neuron cells in whole mounts of major pelvic ganglions were observed five days after injection.

RESULTSElectrical stimulation produced no erection in either the nerve ablation or the graft group, but 100% erection in the sham-operated group after 2 months. The numbers of FG-labeled neurons significantly differed between the nerve ablation group and the graft group. After 4 months erection examination showed statistical significance in the difference between the graft group and the nerve ablation group(P < 0.05). The FG-labeled neurons in the graft group significantly differed from those in the ablation (P < 0.05), and almost reached the level of the sham-operated(P < 0.05).

CONCLUSIONCavernous nerve grafting can successfully restore erectile dysfunction in rats after surgical injury.

Animals ; Electric Stimulation ; Male ; Penile Erection ; Penis ; innervation ; Rats ; Rats, Sprague-Dawley ; Sural Nerve ; transplantation

By studying the novel methods for reconstructing damaged cavernous nerves and the related literature on the regeneration of cavernous nerves, restoration of erectile function and neurohistological reconstruction engineering, a variety of grafting materials have been found applicable to cavernous nerve reconstruction, including autogenetic nerve grafts, silicone tubes, artificial biodegradable conduits and so on. Neurotrophic factors, extra cellular matrix components and Schwann cells have been shown to promote cavernous regeneration. Artificial nerve guides, especially biodegradable ones containing growth-promoting factors or cells, are a promising option for the repair of cavernous nerve lesions.
Erectile Dysfunction ; surgery ; Humans ; Male ; Nerve Regeneration ; Neurosurgical Procedures ; Penis ; innervation ; Schwann Cells

OBJECTIVETo evaluate the effect of sexual-nerve-sparing radical cystectomy.

METHODSThirty-two male patients were treated with sexual-nerve-sparing radical cystectomy in our hospital in the past 5 years. The age of the patients ranged from 38 to 72 years, with the course of the disease ranging from 2 days to 20 years. All of them were potent preoperatively. Radical cystectomy was performed antegradely and retrogradely with the neurovascular bundle spared.

RESULTSThe patients were followed up for 6 to 54 months, 3 achieved sexual activity of Grade I, 6 Grade II and 23 Grade III after the operation. The recovery time of erectile function ranged from 2 to 14 months, averaging at 4. 5 months.

CONCLUSIONWhenever condition suits, sexual-nerve-sparing radical cystectomy is to be strongly recommended.

Adult ; Aged ; Coitus ; Cystectomy ; methods ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Penile Erection ; Penis ; innervation

The injury of the penile cavernous nerve is a common cause of erectile dysfunction (ED). Reconstruction of the resected cavernous nerve can restore penile erectile function to normal. The methods for cavernous nerve repair include direct anastomosis, autotransplantation of the nerve, and substitution of the biodegradable artificial nerve, among which only autotransplantation of the sural nerve is used clinically at present. Besides, the nerve growth factor plays an important role in nerve reconstruction. This paper summarizes the methods of cavernous nerve reconstruction in the recent years.
Humans ; Male ; Nerve Regeneration ; Nerve Tissue ; surgery ; transplantation ; Neurosurgical Procedures ; methods ; Penile Erection ; Penis ; innervation