Penile reconstruction and sensitive reinnervation by end-to-side neurorrhaphy

The aim of total penile reconstruction is to reconstruct the penis in one setting, providing an aesthetically acceptable phallus that allows urination in the orthostatic position and sufficient firmness for the erection to penetrate. However, it is also important to restore erogenous and tactile sensitivities. Reconstructive surgery should include a nerve microsurgery restoration, as the organ has an important sensitive function. Patients who underwent penile reconstruction with microsurgical forearm flaps and end-to-side neurorrhaphies performed between the medial cutaneous nerve of the forearm flap and the ilioinguinal nerve or genitofemoral nerve had sensitivity restored after 3–8 months, depending on the number of nerve grafts used in the reconstructive surgery. The end-to-side neurorrhaphy, reportedly effective for nerve repair, was successfully used in our patients for penile reconstruction and sensitivity reestablishment. This is the first report about the use of end-to-side neurorrhaphy to re-establish sensitivity in penile reconstructions. Level of evidence: Level V, therapeutic study.