(054) DOES NEUROANASTOMOSIS IMPROVE THE PENILE SENSATION RECOVERY AFTER REPLANTATION? A REVIEW OF 109 CASES
Authors: Fuell W , Tran A , Machado B , Hellstrom W 
Published: December 2024

Abstract

Introduction
Penile amputation is a rare phenomenon encountered by urologists with minimal standardization and recommendations regarding surgical decision making. The first large series of penile amputations described in the literature, detailing outcomes of microsurgical versus surgical replantation was just published in 2023. Prior to this study, operative technique, decision-making, and post-operative expectations were largely driven by case reports and small case-series with conflicting results. As gleaned from our plastic surgery colleagues with respect to digital replantation, it has long been thought that primary neuroanastomosis increases the likelihood of return of penile sensory function and should be performed if viable. However, the necessity and efficacy of nerve repair in achieving sensory recovery remain subjects of ongoing debate.

Objective
We aim to provide surgical guidance regarding the necessity of performing nerve repair during microsurgical replantation for penile amputation. We hypothesize that vascular repair alone is the driving force regarding neuroregeneration and recovery of penile sensation.

Methods
The database from the study “The Revised PENIS Score and Proposal of the PACKAGE Checklist: A Meta-Epidemiologic Study on Penile Amputation and Replantation” was utilized for this analysis. The original dataset included a diverse range of cases from various geographical locations and medical settings, providing a robust basis for comparison. Patients who underwent microsurgical replantation, defined by any repair that included anastomosis of vessels or nerves, with and without nerve repair were compared to determine the efficacy and necessity of performing primary nerve repair during penile replantation.

Results
109 patients that underwent microsurgical replantation for penile amputation were identified from the database. Of these 109 patients, 35 underwent primary nerve repair with 18 (51%) having return of near normal sensation. The remaining 74 patients did not have primary nerve repair, with 31 (42%) of these patients having near-normal sensory recovery. Both groups showed a comparable rate of sensory recovery with no statistically significant difference found between the two groups.

Conclusions
Our findings suggest that the return of penile sensation post-replantation is not significantly influenced by the inclusion of primary nerve repair. This effect is likely specific to penile tissue, as similar effects are not observed in digital amputations. This challenges the prevailing assumption that nerve repair is critical for sensory recovery in penile replantation. Given these findings, we currently recommend prioritizing microsurgical vascular repair and reperfusion as being critical for spontaneous neuroregeneration and recovering of penile sensation. Further research with larger sample sizes and standardized in reporting in the literature using the Revised PENIS Score is recommended to validate these findings and guide clinical practices in penile replantation going forward.

Disclosure
No.